Healthcare Provider Details

I. General information

NPI: 1811680812
Provider Name (Legal Business Name): BRENDA KAREN VELASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 WILSHIRE BLVD STE 560
LOS ANGELES CA
90036-5418
US

IV. Provider business mailing address

5700 WILSHIRE BLVD STE 560
LOS ANGELES CA
90036-5418
US

V. Phone/Fax

Practice location:
  • Phone: 213-637-5000
  • Fax:
Mailing address:
  • Phone: 213-637-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: