Provider Demographics
NPI:1730270588
Name:VELASCO, LEOVY ARIAS (DDS)
Entity type:Individual
Prefix:DR
First Name:LEOVY
Middle Name:ARIAS
Last Name:VELASCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 VIA VERDE
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-3424
Mailing Address - Country:US
Mailing Address - Phone:510-276-3691
Mailing Address - Fax:
Practice Address - Street 1:35124 NEWARK BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1220
Practice Address - Country:US
Practice Address - Phone:510-796-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice