Provider Demographics
NPI:1083797583
Name:VELAZQUEZ, PAUL (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:245 PLAZA CAROLINA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-752-2485
Mailing Address - Fax:787-757-4885
Practice Address - Street 1:LOCAL #203
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00988
Practice Address - Country:US
Practice Address - Phone:787-752-2485
Practice Address - Fax:787-757-4885
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU73711Medicare UPIN