Provider Demographics
NPI:1053143271
Name:VELASCO-CEJA, MIGUEL ANGEL (MSW; ACSW)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:VELASCO-CEJA
Suffix:
Gender:M
Credentials:MSW; ACSW
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:ANGEL
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15218 SUMMIT AVE STE 300-214
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0232
Mailing Address - Country:US
Mailing Address - Phone:909-219-4500
Mailing Address - Fax:
Practice Address - Street 1:15218 SUMMIT AVE STE 300-214
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0232
Practice Address - Country:US
Practice Address - Phone:909-219-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1243671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical