Provider Demographics
NPI:1386730786
Name:MEDINA-VELEZ, GISELLE M (PSYD)
Entity type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:M
Last Name:MEDINA-VELEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DEL GOLF CLUB
Mailing Address - Street 2:510 LUIS MORALES
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO EPISCOPAL SAN LUCAS
Practice Address - Street 2:917 AVE. TITO CASTRO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-844-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR563472OtherFHC SYSTEMS
PR3016OtherAPS HEALTH
PR57267 MEOtherTRIPLE S INC.
PR563472OtherFHC SYSTEMS
PR3016OtherAPS HEALTH
PRQ-49668Medicare UPIN