Provider Demographics
NPI:1770326746
Name:VELAZCO GARCIA, HEIDYS
Entity type:Individual
Prefix:
First Name:HEIDYS
Middle Name:
Last Name:VELAZCO GARCIA
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 1:19660 SW 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4459
Mailing Address - Country:US
Mailing Address - Phone:786-661-8784
Mailing Address - Fax:
Practice Address - Street 1:19660 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4459
Practice Address - Country:US
Practice Address - Phone:786-661-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty