Provider Demographics
NPI:1477903987
Name:VELASQUEZ, NATHALIA (MD)
Entity type:Individual
Prefix:DR
First Name:NATHALIA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NATHALIA
Other - Middle Name:
Other - Last Name:GARCIA-LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:39983 POTRERO DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5603
Mailing Address - Country:US
Mailing Address - Phone:650-400-2649
Mailing Address - Fax:
Practice Address - Street 1:39400 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2310
Practice Address - Country:US
Practice Address - Phone:510-248-3085
Practice Address - Fax:954-659-5787
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87520207YX0602X
CAA192748207YX0602X
FLME156237207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy