Healthcare Provider Details

I. General information

NPI: 1023892353
Provider Name (Legal Business Name): SALMA VELASQUEZ MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 SW CAPTAINS PL
PALM CITY FL
34990-1747
US

IV. Provider business mailing address

154 W 22ND ST
RIVIERA BEACH FL
33404-5512
US

V. Phone/Fax

Practice location:
  • Phone: 772-266-8727
  • Fax: 772-494-7093
Mailing address:
  • Phone: 561-318-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-294988
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: