Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A38287 | CA |
NPI | 1477601201 |
---|---|
Provider Name | Roberto U. Velasco |
First Address | Bellflower, CA 90706-2246 |
Second Address | Bellflower, CA 90706-2246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 29/11/2021 |