Provider Demographics
NPI:1639501562
Name:VELEZ, MARI ROSA (PH D)
Entity Type:Individual
Prefix:MRS
First Name:MARI
Middle Name:ROSA
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CASA 6 URB. VILLA MILAGROS
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0062
Mailing Address - Country:US
Mailing Address - Phone:787-307-1885
Mailing Address - Fax:
Practice Address - Street 1:CARR 103 INTERIOR KM12.1
Practice Address - Street 2:VILLA MILAGROS CASA 6
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-0062
Practice Address - Country:US
Practice Address - Phone:787-307-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical