Provider Demographics
NPI:1093566085
Name:VELAZQUEZ CRUZ, DANIELA J
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:J
Last Name:VELAZQUEZ CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17524 SW 143RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6675
Mailing Address - Country:US
Mailing Address - Phone:786-337-5573
Mailing Address - Fax:
Practice Address - Street 1:17524 SW 143RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6675
Practice Address - Country:US
Practice Address - Phone:786-337-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-316520103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst