Provider Demographics
NPI:1043382070
Name:FERNANDO J VELASQUEZ MD PA
Entity Type:Organization
Organization Name:FERNANDO J VELASQUEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-879-1985
Mailing Address - Street 1:2906 WEST TAMPA BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1233
Mailing Address - Country:US
Mailing Address - Phone:813-879-1985
Mailing Address - Fax:813-876-0336
Practice Address - Street 1:2906 WEST TAMPA BAY BOULEVARD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1233
Practice Address - Country:US
Practice Address - Phone:813-879-1985
Practice Address - Fax:813-876-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77331OtherBCBS
D56617Medicare UPIN