Provider Demographics
NPI:1104616044
Name:ESTARELLAS VELEZ, AGUSTIN A
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:A
Last Name:ESTARELLAS VELEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CALLE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-3214
Mailing Address - Country:US
Mailing Address - Phone:787-871-2211
Mailing Address - Fax:
Practice Address - Street 1:6 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3214
Practice Address - Country:US
Practice Address - Phone:787-871-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7792103TS0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool