Provider Demographics
NPI:1467982975
Name:VELASQUEZ, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:VELASQUEZ
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 1:348 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3531
Mailing Address - Country:US
Mailing Address - Phone:551-313-5758
Mailing Address - Fax:
Practice Address - Street 1:123 NW 13TH ST STE 305B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1645
Practice Address - Country:US
Practice Address - Phone:786-230-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-16
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst