Provider Demographics
NPI:1083865869
Name:OCTAVIO PEREZ-VELASCO M D P A
Entity Type:Organization
Organization Name:OCTAVIO PEREZ-VELASCO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-964-0595
Mailing Address - Street 1:1312 W FLETCHER AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3330
Mailing Address - Country:US
Mailing Address - Phone:813-964-0595
Mailing Address - Fax:813-963-5071
Practice Address - Street 1:1312 W FLETCHER AVE
Practice Address - Street 2:STE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3330
Practice Address - Country:US
Practice Address - Phone:813-964-0595
Practice Address - Fax:813-963-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81174261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care