Provider Demographics
NPI:1083149074
Name:VELAZQUEZ RODRIGUEZ, REYNERIO YOANDRYS
Entity Type:Individual
Prefix:
First Name:REYNERIO
Middle Name:YOANDRYS
Last Name:VELAZQUEZ RODRIGUEZ
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 1:175 FONTAINEBLEAU BLVD STE 2A5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 2A5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7013
Practice Address - Country:US
Practice Address - Phone:305-554-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health