MEDICARE: JERALYS MARIE VELAZQUEZ SANTIAGO PSICOLOGA

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	8948	PR

General Provider Information

NPI Number	:	1932058179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERALYS MARIE VELAZQUEZ SANTIAGO PSICOLOGA

Provider Business Mailing Address
First Line	:	URB. EL PEDREGAL 115 CALLE MARMOL
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-8522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PARKING VISTA VERDE, CLL ZAFIRO
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682
Country	:	US
Telephone Number	:	787-597-7061
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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