Provider Demographics
NPI:1689204794
Name:VELAZQUEZ, MARIA MELISA
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MELISA
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:MELISA
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:100 GRAND PASEO BOULEVARD
Mailing Address - Street 2:SUITE 112, MSC 436
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-363-0215
Mailing Address - Fax:
Practice Address - Street 1:MONTE ATENAS OFFICE PARK SUITE 215
Practice Address - Street 2:AVE. LAS CUMBRES KM4.0
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-363-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty