1194399691 NPI number — VELOSA J.C DENTAL PRACTICE CORP

Table of content: (NPI 1194399691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194399691 NPI number — VELOSA J.C DENTAL PRACTICE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VELOSA J.C DENTAL PRACTICE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194399691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 E 17TH ST STE E227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92701-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-550-0503
Provider Business Mailing Address Fax Number:
714-550-4112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 E 17TH ST STE E227
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-550-0503
Provider Business Practice Location Address Fax Number:
714-550-4112
Provider Enumeration Date:
05/18/2021

Additional Information

Authorized Official

Authorized Official Last Name:
VELOSA
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
CARLOS
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
626-840-6862

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com