Healthcare Provider Details

I. General information

NPI: 1558993865
Provider Name (Legal Business Name): IRAN SANCHEZ VELAZCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20105 SW 122ND AVE APT 104
MIAMI FL
33177-5277
US

IV. Provider business mailing address

20105 SW 122ND AVE APT 104
MIAMI FL
33177-5277
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-9134
  • Fax:
Mailing address:
  • Phone: 786-553-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88463
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-110172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: