Healthcare Provider Details

I. General information

NPI: 1841838596
Provider Name (Legal Business Name): KRISTAL VELAZQUEZ CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GRAND ST
HARTFORD CT
06106-1541
US

IV. Provider business mailing address

60 NORWOOD AVE
HAMDEN CT
06518-2606
US

V. Phone/Fax

Practice location:
  • Phone: 860-550-7500
  • Fax:
Mailing address:
  • Phone: 203-668-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number461
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: