Provider Demographics
NPI:1730250010
Name:VELASCO, RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:VELASCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:SUITE 603
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2228
Mailing Address - Country:US
Mailing Address - Phone:650-993-8800
Mailing Address - Fax:650-993-8607
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 603
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:650-993-8800
Practice Address - Fax:650-993-8607
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A621820Medicaid
CAH11964Medicare UPIN
CA00A621822Medicare ID - Type Unspecified