Provider Demographics
NPI:1205509684
Name:VELAZQUEZ, LEENED MARIE
Entity type:Individual
Prefix:
First Name:LEENED
Middle Name:MARIE
Last Name:VELAZQUEZ
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 1:11765 POETRY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5099
Mailing Address - Country:US
Mailing Address - Phone:787-410-0162
Mailing Address - Fax:
Practice Address - Street 1:11765 POETRY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5099
Practice Address - Country:US
Practice Address - Phone:787-410-0162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program