Healthcare Provider Details

I. General information

NPI: 1497682678
Provider Name (Legal Business Name): YANIRA C VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 53RD AVE
OAKLAND CA
94601-5728
US

IV. Provider business mailing address

8141 IDLEWOOD ST
OAKLAND CA
94605-3446
US

V. Phone/Fax

Practice location:
  • Phone: 510-397-9706
  • Fax:
Mailing address:
  • Phone: 510-397-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number240025490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: