Provider Demographics
NPI:1730709197
Name:VELASCO, RYAN (RRT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:VELASCO
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15575 JOLIET CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3198
Mailing Address - Country:US
Mailing Address - Phone:909-525-8183
Mailing Address - Fax:
Practice Address - Street 1:15575 JOLIET CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3198
Practice Address - Country:US
Practice Address - Phone:909-525-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38772227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered