Provider Demographics
NPI:1861268799
Name:VELAZQUEZ AGUILERA, AILIN
Entity type:Individual
Prefix:
First Name:AILIN
Middle Name:
Last Name:VELAZQUEZ AGUILERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 NW 170 TER
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055
Mailing Address - Country:US
Mailing Address - Phone:786-277-9792
Mailing Address - Fax:
Practice Address - Street 1:5401 NW 170 TER
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33055-3305
Practice Address - Country:US
Practice Address - Phone:786-277-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-291384106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician