Provider Demographics
NPI:1699215376
Name:ALICEA-VELEZ, OMAR ENRIQUE (PHD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:ENRIQUE
Last Name:ALICEA-VELEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. MONTE ALTO #156 CALLE EL CACIQUE
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-4081
Mailing Address - Country:US
Mailing Address - Phone:787-384-5551
Mailing Address - Fax:
Practice Address - Street 1:104 CALLE ANDRES ARUS RIVERA W
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2318
Practice Address - Country:US
Practice Address - Phone:787-687-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4065235Z00000X
PR5756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist