Provider Demographics
NPI:1003632266
Name:IRIZARRY VELEZ, OSVALDO EMILIO (PHD)
Entity type:Individual
Prefix:
First Name:OSVALDO
Middle Name:EMILIO
Last Name:IRIZARRY VELEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:MARICAO
Mailing Address - State:PR
Mailing Address - Zip Code:00606-0001
Mailing Address - Country:US
Mailing Address - Phone:939-339-1146
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1
Practice Address - Street 2:
Practice Address - City:MARICAO
Practice Address - State:PR
Practice Address - Zip Code:00606-0001
Practice Address - Country:US
Practice Address - Phone:939-339-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008172103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist