Provider Demographics
NPI:1467240507
Name:VELAZQUEZ OQUENDO, LUIS R
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:R
Last Name:VELAZQUEZ OQUENDO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CALLE SOL
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4881
Mailing Address - Country:US
Mailing Address - Phone:787-284-2900
Mailing Address - Fax:
Practice Address - Street 1:120 CALLE SOL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4881
Practice Address - Country:US
Practice Address - Phone:787-284-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8314103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty