Healthcare Provider Details

I. General information

NPI: 1053216127
Provider Name (Legal Business Name): DENISSE IVELISSE RIJO VELAZQUEZ MRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 CALLE GAUTIER BENITEZ
SAN JUAN PR
00915-4027
US

IV. Provider business mailing address

662 CALLE GAUTIER BENITEZ BARRIO OBRERO
SAN JUAN PR
00915-4027
US

V. Phone/Fax

Practice location:
  • Phone: 787-903-0390
  • Fax:
Mailing address:
  • Phone: 787-903-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number1918
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: