Healthcare Provider Details

I. General information

NPI: 1275502353
Provider Name (Legal Business Name): GLENDA L VELEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CALLE JOSE I QUINTON SUITE 7
COAMO PR
00769-3050
US

IV. Provider business mailing address

15422 CALLE FLAMBOYAN PASEO JACARANDA
SANTA ISABEL PR
00757-9621
US

V. Phone/Fax

Practice location:
  • Phone: 787-632-1179
  • Fax:
Mailing address:
  • Phone: 787-632-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2158
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: