Basic Information
| Provider Information | |||||||||
| NPI: | 1609464114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELASQUEZ ROSALES | ||||||||
| FirstName: | NORMITA | ||||||||
| MiddleName: | RAQUEL | ||||||||
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| Credential: | PT41847 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6119 DANNY DR UNIT 16 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952105324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082073025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1947 N CALIFORNIA ST STE BANDC | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952046029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094630870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2021 | ||||||||
| LastUpdateDate: | 01/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT41847 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.