Healthcare Provider Details

I. General information

NPI: 1275942112
Provider Name (Legal Business Name): CHARITY VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARITY HECHT

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

IV. Provider business mailing address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

V. Phone/Fax

Practice location:
  • Phone: 209-622-1420
  • Fax:
Mailing address:
  • Phone: 209-353-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: