Individual
ALFREDO VELAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
189 N E ST, SAN BERNARDINO, CA 92401-1901
(909) 383-8328
(909) 383-8332
Mailing address
189 N E ST, SAN BERNARDINO, CA 92401-1901
(909) 383-8328
(909) 383-8332
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
44119
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
273631265
TAX ID
CA
01
—
330985090
TAX ID
CA
Enumeration date
07/20/2006
Last updated
01/18/2017
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