Provider Demographics
NPI:1447026505
Name:VELAZQUEZ, GAVIN CADE
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:CADE
Last Name:VELAZQUEZ
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 1:670 CUPOTA DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-6250
Mailing Address - Country:US
Mailing Address - Phone:440-387-9725
Mailing Address - Fax:
Practice Address - Street 1:670 CUPOTA DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-6250
Practice Address - Country:US
Practice Address - Phone:440-387-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician