Individual
JANINE M VELASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18321 CLARK ST, TARZANA, CA 91356-3501
(802) 708-5172
Mailing address
15054 PROVIDENCE LN, NORTH HILLS, CA 91343-3477
(808) 213-1077
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
703535
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
703535
—
CA
Enumeration date
05/22/2019
Last updated
05/22/2019
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