Provider Demographics
NPI:1093432239
Name:VELAZQUEZ VALDES, RENE
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:VELAZQUEZ VALDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14341 SW 258TH LN APT 2109
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6766
Mailing Address - Country:US
Mailing Address - Phone:786-768-9116
Mailing Address - Fax:
Practice Address - Street 1:14341 SW 258TH LN APT 2109
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6766
Practice Address - Country:US
Practice Address - Phone:786-768-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT22231906106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician