Provider Demographics
NPI:1780315945
Name:VELAZQUEZ MUNIZ, LISANGELEE
Entity type:Individual
Prefix:
First Name:LISANGELEE
Middle Name:
Last Name:VELAZQUEZ MUNIZ
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 1:2009 LAGUNA DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-5681
Mailing Address - Country:US
Mailing Address - Phone:321-732-3723
Mailing Address - Fax:321-352-7168
Practice Address - Street 1:6000 TURKEY LAKE RD STE 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4205
Practice Address - Country:US
Practice Address - Phone:321-732-3723
Practice Address - Fax:321-352-7168
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician