Provider Demographics
NPI:1912430489
Name:VELAZCO, YAZMIN
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:VELAZCO
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 1:18304 SW 146TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3340
Mailing Address - Country:US
Mailing Address - Phone:305-300-0207
Mailing Address - Fax:404-601-0202
Practice Address - Street 1:18304 SW 146TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3340
Practice Address - Country:US
Practice Address - Phone:305-300-0207
Practice Address - Fax:404-601-0202
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15810224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant