Provider Demographics
NPI:1760029011
Name:VELEZ BRUCKMAN, RAISA
Entity Type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:VELEZ BRUCKMAN
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 1:420 S ESPLANADE ST APT F001
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1518
Mailing Address - Country:US
Mailing Address - Phone:830-358-2233
Mailing Address - Fax:
Practice Address - Street 1:420 S ESPLANADE ST APT F001
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1518
Practice Address - Country:US
Practice Address - Phone:830-822-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist