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General NPI Number Information
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NPI Number | 1205287216
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Entity Type | Individual
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Provider Name | GLICELDA VELASCO PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 01/23/2021
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Provider Practice Location Address
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Address Line | 233 E WEDDELL DR STE A
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City | SUNNYVALE
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State | CA
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Zip | 94089-1659
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Country | US
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Telephone | 510-766-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 31380 SAN ANDREAS DR
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City | UNION CITY
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State | CA
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Zip | 94587-2859
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Country | US
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Telephone | 408-203-8421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 624603
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95010659
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95010659
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License Number State | CA
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