Provider Demographics
NPI:1114016417
Name:VELEZ PASTRANA, MARIA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:C
Last Name:VELEZ PASTRANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CALLE PRINCESA
Mailing Address - Street 2:URB ADOQUINES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7357
Mailing Address - Country:US
Mailing Address - Phone:787-547-0513
Mailing Address - Fax:787-758-3029
Practice Address - Street 1:265 CALLE SIERRA MORENA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5573
Practice Address - Country:US
Practice Address - Phone:787-547-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1662103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR515263OtherMCS
PR56667VEOtherTRIPLE S