MEDICARE: DR. MARIA C VELEZ PASTRANA PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1662	PR
2	103TC0700X	Clinical Psychologist	1662	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515263	OTHER	PR	MCS
2	56667VE	OTHER	PR	TRIPLE S

General Provider Information

NPI Number	:	1114016417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA C VELEZ PASTRANA PH.D.

Provider Business Mailing Address
First Line	:	51 CALLE PRINCESA
Second Line	:	URB ADOQUINES
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7357
Country	:	US
Telephone Number	:	787-547-0513
Fax Number	:	787-758-3029

Provider Business Practice Location Address
First Line	:	265 CALLE SIERRA MORENA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5573
Country	:	US
Telephone Number	:	787-547-0513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/02/2020

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