Provider Demographics
NPI:1790387181
Name:VELAZCO, TAIMY
Entity Type:Individual
Prefix:
First Name:TAIMY
Middle Name:
Last Name:VELAZCO
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 1:6821 SW 129TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2465
Mailing Address - Country:US
Mailing Address - Phone:786-328-0359
Mailing Address - Fax:
Practice Address - Street 1:6821 SW 129TH AVE APT 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2465
Practice Address - Country:US
Practice Address - Phone:786-328-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician