Provider Demographics
NPI:1982832366
Name:VELEZ SANTIAGO, JOSE RAFAEL (PSY-D)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAFAEL
Last Name:VELEZ SANTIAGO
Suffix:
Gender:M
Credentials:PSY-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 CALLE CUPIDO
Mailing Address - Street 2:VENUS GARDEN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4804
Mailing Address - Country:US
Mailing Address - Phone:787-983-4883
Mailing Address - Fax:787-993-2229
Practice Address - Street 1:1790 CALLE JULIO AYBAR
Practice Address - Street 2:URB. SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4410
Practice Address - Country:US
Practice Address - Phone:787-983-4883
Practice Address - Fax:787-993-2229
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical