Healthcare Provider Details

I. General information

NPI: 1801072996
Provider Name (Legal Business Name): AGUEDA VELAZQUEZ-HEALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AGUEDA FONTES

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 FAIR OAKS BLVD
SACRAMENTO CA
95825-4708
US

IV. Provider business mailing address

5820 OWENS DR BLDG E2ND
PLEASANTON CA
94588-3900
US

V. Phone/Fax

Practice location:
  • Phone: 916-541-4719
  • Fax: 877-738-4262
Mailing address:
  • Phone: 916-973-5000
  • Fax: 877-738-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65831
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: