Provider Demographics
NPI:1255623450
Name:VELARDE, MARIA CRISTINA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CRISTINA
Last Name:VELARDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 LINDERO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-5455
Mailing Address - Country:US
Mailing Address - Phone:818-865-8006
Mailing Address - Fax:818-865-8796
Practice Address - Street 1:608 LINDERO CANYON RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-5455
Practice Address - Country:US
Practice Address - Phone:818-865-8006
Practice Address - Fax:818-865-8796
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice