Provider Demographics
NPI:1487400701
Name:ANAYA VELAZQUEZ, ADILENE
Entity type:Individual
Prefix:
First Name:ADILENE
Middle Name:
Last Name:ANAYA VELAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 MCMILLAN AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6765
Mailing Address - Country:US
Mailing Address - Phone:805-781-4948
Mailing Address - Fax:805-781-4962
Practice Address - Street 1:2925 MCMILLAN AVE STE 108
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6765
Practice Address - Country:US
Practice Address - Phone:805-781-4948
Practice Address - Fax:805-781-4962
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker