Healthcare Provider Details

I. General information

NPI: 1477202208
Provider Name (Legal Business Name): HETALBEN NAGINBHAI VELLANKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HETAL VELLANKI FNP

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39141 CIVIC CENTER DR STE 130
FREMONT CA
94538-5831
US

IV. Provider business mailing address

39300 CIVIC CENTER DR STE 370
FREMONT CA
94538-2397
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-1680
  • Fax:
Mailing address:
  • Phone: 510-248-1000
  • Fax: 510-792-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: