Healthcare Provider Details

I. General information

NPI: 1912820507
Provider Name (Legal Business Name): JANET VELASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S PROSPERO DR
GLENDORA CA
91740-4964
US

IV. Provider business mailing address

1259 S PROSPERO DR
GLENDORA CA
91740-4964
US

V. Phone/Fax

Practice location:
  • Phone: 323-683-5106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC23125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: