Provider Demographics
NPI:1588926422
Name:CORA-VELASQUEZ, GLORIA MARIA (MS)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:MARIA
Last Name:CORA-VELASQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HOWE AVE.
Mailing Address - Street 2:APT # 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473
Mailing Address - Country:US
Mailing Address - Phone:718-794-4507
Mailing Address - Fax:718-794-4507
Practice Address - Street 1:304 HOWE AVE
Practice Address - Street 2:APT. 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1644
Practice Address - Country:US
Practice Address - Phone:718-794-4507
Practice Address - Fax:718-794-4507
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO74020605171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor