Healthcare Provider Details

I. General information

NPI: 1205287216
Provider Name (Legal Business Name): GLICELDA VELASCO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E WEDDELL DR STE A
SUNNYVALE CA
94089-1659
US

IV. Provider business mailing address

31380 SAN ANDREAS DR
UNION CITY CA
94587-2859
US

V. Phone/Fax

Practice location:
  • Phone: 510-766-4060
  • Fax:
Mailing address:
  • Phone: 408-203-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number624603
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010659
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95010659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: