Provider Demographics
NPI:1508556911
Name:VELAZQUEZ, JURAJ
Entity type:Individual
Prefix:
First Name:JURAJ
Middle Name:
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 1:11230 SW 40TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4602
Mailing Address - Country:US
Mailing Address - Phone:305-721-5450
Mailing Address - Fax:
Practice Address - Street 1:2915 BISCAYNE BLVD STE 200-12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4155
Practice Address - Country:US
Practice Address - Phone:305-537-6697
Practice Address - Fax:305-489-0698
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-25-78938103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst