Healthcare Provider Details

I. General information

NPI: 1851236608
Provider Name (Legal Business Name): VANESSA VELAZCO ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 ZANKER RD
SAN JOSE CA
95134-2130
US

IV. Provider business mailing address

3626 PRESCOTT AVE
SAN JOSE CA
95124-2919
US

V. Phone/Fax

Practice location:
  • Phone: 408-661-9468
  • Fax:
Mailing address:
  • Phone: 408-661-9468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberLCSW66335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: