Healthcare Provider Details

I. General information

NPI: 1295655140
Provider Name (Legal Business Name): YANIA MICHELLE VELAZQUEZ-DE JESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO SANTO DOMINGO 1, STREET 10 324
PENUELAS PR
00624-9693
US

IV. Provider business mailing address

HC 2 BOX 5410
PENUELAS PR
00624-9693
US

V. Phone/Fax

Practice location:
  • Phone: 939-390-0753
  • Fax:
Mailing address:
  • Phone: 939-390-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1413
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: