Individual provider Active NPI

Gladys Marina Veltkamp, PHD

  • Clinical Neuropsychologist
  • Palo Alto, CA
National Provider Identifier
1922555275
Registry record updated Sep 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
4353 Issued in PR
Practice address
3801 Miranda Ave
Palo Alto, CA 94304-1207
Phone
(650) 493-5000
NPI assigned
Sep 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 4353 PR Primary
Clinical Psychologist 103TC0700X 4353 PR

Addresses

Primary practice location

3801 Miranda Ave
Palo Alto, CA 94304-1207

Mailing address

1486 Carnot Dr
San Jose, CA 95126-4304
Phone (650) 210-6258

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4353PRMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472860800000",
    "number": "1922555275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1486 CARNOT DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951264304",
            "telephone_number": "650-210-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 MIRANDA AVE",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041207",
            "telephone_number": "650-493-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELTKAMP",
        "first_name": "GLADYS",
        "middle_name": "MARINA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-03",
        "last_updated": "2016-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "PR",
            "license": "4353",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "4353",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.