=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477202208
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HETALBEN NAGINBHAI VELLANKI FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2022
-----------------------------------------------------
Last Update Date | 09/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39141 CIVIC CENTER DR STE 130
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-5831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-248-1680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39300 CIVIC CENTER DR STE 370
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-2397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-248-1000
-----------------------------------------------------
Fax | 510-792-2499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95019987
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------