Provider Demographics
NPI:1801072996
Name:VELAZQUEZ-HEALY, AGUEDA
Entity type:Individual
Prefix:
First Name:AGUEDA
Middle Name:
Last Name:VELAZQUEZ-HEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AGUEDA
Other - Middle Name:
Other - Last Name:FONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5820 OWENS DR BLDG E2ND
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3900
Mailing Address - Country:US
Mailing Address - Phone:916-973-5000
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:2345 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4708
Practice Address - Country:US
Practice Address - Phone:916-541-4719
Practice Address - Fax:877-738-4262
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA658311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator