Healthcare Provider Details

I. General information

NPI: 1114016417
Provider Name (Legal Business Name): MARIA C VELEZ PASTRANA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 CALLE SIERRA MORENA
SAN JUAN PR
00926-5573
US

IV. Provider business mailing address

51 CALLE PRINCESA URB ADOQUINES
SAN JUAN PR
00926-7357
US

V. Phone/Fax

Practice location:
  • Phone: 787-547-0513
  • Fax:
Mailing address:
  • Phone: 787-547-0513
  • Fax: 787-758-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1662
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1662
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: