Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | MD451816 | PA |
NPI | 1275852147 |
---|---|
Provider Name | Jeanne Michelle Velasco |
First Address | Philadelphia, PA 19134-1011 |
Second Address | Philadelphia, PA 19134-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 22/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD451816 | COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE (01) | PA |