Individual provider Active NPI

Paola Beatriz Velazquez- Gonzalez, DR

  • Clinical Neuropsychologist
  • Grand Rapids, MI
National Provider Identifier
1215855457
Registry record updated Aug 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
6301019869 Issued in MI
Practice address
35 Michigan St NE
Grand Rapids, MI 49503-2514
Phone
(616) 267-2500
NPI assigned
Jul 7, 2026
Last updated
Aug 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 6301019869 MI Primary

Addresses

Primary practice location

35 Michigan St NE
Grand Rapids, MI 49503-2514

Mailing address

113 Larkin Dr
Mechanicsburg, PA 17055-5238
Phone (787) 241-6973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1783382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1215855457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LARKIN DR",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170555238",
            "telephone_number": "787-241-6973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032514",
            "telephone_number": "616-267-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELAZQUEZ- GONZALEZ",
        "first_name": "PAOLA",
        "middle_name": "BEATRIZ",
        "name_prefix": "Dr.",
        "credential": "DR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-07-07",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301019869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.