Healthcare Provider Details

I. General information

NPI: 1831842699
Provider Name (Legal Business Name): CHRISTIAN GABRIEL VELEZ RODRIGUEZ MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 LAKE FOUNTAIN DR APT 121
ORLANDO FL
32839-2293
US

IV. Provider business mailing address

1972 LAKE FOUNTAIN DR APT 121
ORLANDO FL
32839-2293
US

V. Phone/Fax

Practice location:
  • Phone: 787-235-8070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number15797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: