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General NPI Number Information
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NPI Number | 1861635963
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Entity Type | Organization
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Legal Business Name | CENTRO DE EVALUACION Y TERAPIA BRUNILDA VELAZQUEZ TORRES
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | BORGONA STREET 3 B-3 URB. VILLA DEL REY 3RD SECTION
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-375-7259
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Fax | 787-737-8437
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Provider Business Mailing Address
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Address Line | PO BOX 7505
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City | CAGUAS
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State | PR
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Zip | 00726-7505
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Country | US
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Telephone | 787-375-7259
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Fax | 787-737-8437
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BRUNILDA VELAZQUEZ TORRES
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Credential | MS
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Telephone | 787-375-7259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2312
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License Number State | PR
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