Provider Demographics
NPI:1588840359
Name:VELEZ, ILIANA BEATRIZ
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:BEATRIZ
Last Name:VELEZ
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 1:10925 PINEWOOD COVE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3427
Mailing Address - Country:US
Mailing Address - Phone:407-222-3069
Mailing Address - Fax:
Practice Address - Street 1:10925 PINEWOOD COVE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3427
Practice Address - Country:US
Practice Address - Phone:407-222-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist