Healthcare Provider Details

I. General information

NPI: 1124249370
Provider Name (Legal Business Name): NORMA VELAZQUEZ M.E
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PABELLON C SEGUNDO PISO ANEXO PSIQUIATRIA FORENSE
PONCE PR
00732-7321
US

IV. Provider business mailing address

ALTURAS DE PENUELAS II CALLE 12 F1
PENUELAS PR
00624
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-1240
  • Fax: 787-844-1144
Mailing address:
  • Phone: 787-836-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number101Y00000X
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: