Healthcare Provider Details

I. General information

NPI: 1023348380
Provider Name (Legal Business Name): PATRICIA ALEJANDRA VELAZQUEZ PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2010
Last Update Date: 04/17/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DRIVE SUITE 302 A
SANTA FE NM
87505-5588
US

IV. Provider business mailing address

1304 AVENIDA ALISO
SANTA FE NM
87501-1602
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-1558
  • Fax:
Mailing address:
  • Phone: 505-660-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0148551
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1654
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: