Pena-Velasco, Gustavo

Pena-Velasco, Gustavo is an individual health care provider with primary practice located at 3950 Veterans Dr Suite 100, Saint Cloud MN 56303-3410. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Pena-Velasco, Gustavo can be contacted via phone (320) 252-3611.

Contact Information

Primary practice address
3950 Veterans Dr Suite 100 Saint Cloud MN 56303-3410
Phone: (320) 252-3611
Fax: (320) 252-7574
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X D10925 Minnesota

Profile Details

NPI number 1851346639
LBN Legal business name Pena-Velasco, Gustavo
Credentials D.D.S., M.S.
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2006
Last updated Mar 14th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851346639 NPPES
Minnesota MEDICAID 976017200

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