Provider Demographics
NPI:1528568912
Name:VELAZQUEZ, ANA C (CPL 1235)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:C
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:CPL 1235
Other - Prefix:MRS
Other - First Name:ANA
Other - Middle Name:C
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPL 1235
Mailing Address - Street 1:MM11 CALLE 39
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-4139
Mailing Address - Country:US
Mailing Address - Phone:787-478-4058
Mailing Address - Fax:
Practice Address - Street 1:MM11 CALLE 39
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-4139
Practice Address - Country:US
Practice Address - Phone:787-478-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional