Provider Demographics
NPI:1750458196
Name:CAMPOS VELAZQUEZ, ELMO (PHD)
Entity type:Individual
Prefix:
First Name:ELMO
Middle Name:
Last Name:CAMPOS VELAZQUEZ
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:SUITE 444 PMB 90 AVE RIO HONDO
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3113
Mailing Address - Country:US
Mailing Address - Phone:787-795-0280
Mailing Address - Fax:787-795-0280
Practice Address - Street 1:AVE. ESPIRITU SAVITO NO 1 RIO HONDO
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3113
Practice Address - Country:US
Practice Address - Phone:787-795-0280
Practice Address - Fax:787-795-0280
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000852103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S45871Medicare UPIN
PR089208Medicare UPIN