Basic Information
| Provider Information | |||||||||
| NPI: | 1467173534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELAZQUEZ | ||||||||
| FirstName: | RUBEN | ||||||||
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| Credential: | AMFT132799 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5214F DIAMOND HEIGHTS #3366 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152739135 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 ELM ST STE 212 | ||||||||
| Address2: | |||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940703070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505919623 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2022 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 132799 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.