Provider Demographics
NPI:1629401211
Name:GONZALEZ-VELASCO, MILAGROS MAUREEN
Entity Type:Individual
Prefix:MRS
First Name:MILAGROS
Middle Name:MAUREEN
Last Name:GONZALEZ-VELASCO
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 1:104 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3806
Mailing Address - Country:US
Mailing Address - Phone:917-202-9314
Mailing Address - Fax:
Practice Address - Street 1:104 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3806
Practice Address - Country:US
Practice Address - Phone:917-202-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY459543041174400000X
NY6063135051174400000X
NY6441720251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY644172051OtherPRE-KINDERGARTEN, KINDERGARTEN, AND GRADES 1-6
NY603135051OtherBILINGUAL EDUCATION EXTENSTION
NY459543041OtherPERMANENT SPECIAL EDCUCATION LICENSE