Healthcare Provider Details

I. General information

NPI: 1285953224
Provider Name (Legal Business Name): IVELIZ VAZQUEZ-HERNANDEZ MPH, OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 CARR 844
SAN JUAN PR
00926-4446
US

IV. Provider business mailing address

410 CALLE DRESDE VILLA BORINQUEN
SAN JUAN PR
00920-3709
US

V. Phone/Fax

Practice location:
  • Phone: 787-647-1266
  • Fax:
Mailing address:
  • Phone: 787-645-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number741
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number741
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: