Healthcare Provider Details

I. General information

NPI: 1477903987
Provider Name (Legal Business Name): NATHALIA VELASQUEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATHALIA GARCIA-LEON M.D

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

IV. Provider business mailing address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-3085
  • Fax: 954-659-5787
Mailing address:
  • Phone: 510-675-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberA192748
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number87520
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: