Provider Demographics
NPI:1962914929
Name:VELASQUEZ, NELSON JOSE
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:JOSE
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12929 SW 135TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7026
Mailing Address - Country:US
Mailing Address - Phone:305-510-8937
Mailing Address - Fax:
Practice Address - Street 1:12929 SW 135TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7026
Practice Address - Country:US
Practice Address - Phone:305-510-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst