Healthcare Provider Details

I. General information

NPI: 1225877467
Provider Name (Legal Business Name): ERIKA LILIANA VELASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A-11
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

1119 E ELK AVE APT 2
GLENDALE CA
91205-1347
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-4240
  • Fax:
Mailing address:
  • Phone: 408-706-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: