Provider Demographics
NPI:1497505259
Name:VELAZQUEZ BARBAN, KENNY
Entity Type:Individual
Prefix:
First Name:KENNY
Middle Name:
Last Name:VELAZQUEZ BARBAN
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 1:818 E MOWRY DR APT 909
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-8138
Mailing Address - Country:US
Mailing Address - Phone:786-735-7240
Mailing Address - Fax:
Practice Address - Street 1:818 E MOWRY DR APT 909
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-8138
Practice Address - Country:US
Practice Address - Phone:786-735-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician