Healthcare Provider Details

I. General information

NPI: 1548170921
Provider Name (Legal Business Name): VICTOR MANUEL VELAZQUEZ MONTES CBHCM, MA, BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 DAIRY RD
WEST MELBOURNE FL
32904-4046
US

IV. Provider business mailing address

2300 WOODLAKE DR NE APT 202
PALM BAY FL
32905-3233
US

V. Phone/Fax

Practice location:
  • Phone: 772-873-8811
  • Fax: 772-873-8800
Mailing address:
  • Phone: 321-272-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: