Healthcare Provider Details

I. General information

NPI: 1558071928
Provider Name (Legal Business Name): YOEL JESUS DE VELASCO OJEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 1ST ST FL 2
MIAMI FL
33135-1601
US

IV. Provider business mailing address

16152 SW 288TH ST
HOMESTEAD FL
33033-1163
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-8931
  • Fax:
Mailing address:
  • Phone: 305-766-9348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: