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General NPI Number Information
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NPI Number | 1679793731
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Entity Type | Individual
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Provider Name | ENID VELAZQUEZ M.S.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | LC INSURANCE BUILDING CARR 183 KM 10.4 BO QUEMADOS
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City | SAN LORENZO
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State | PR
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Zip | 00754-4507
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Country | US
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Telephone | 787-635-8519
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Fax | 787-736-7805
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Provider Business Mailing Address
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Address Line | JARDINES DE CERRO GORDO ST 4 B 5
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City | SAN LORENZO
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State | PUERTO RICO
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Zip | 00754 4507
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Country | UM
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Telephone | 787-635-8519
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Fax | 787-736-7805
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1548
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License Number State | PR
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