Provider Demographics
NPI:1114075140
Name:VELAZQUEZ, VANESSA (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PLAZA SILVESTRE
Mailing Address - Street 2:ENTRERIOS
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6169
Mailing Address - Country:US
Mailing Address - Phone:787-283-0421
Mailing Address - Fax:787-750-0195
Practice Address - Street 1:GO4-B CAMPO RICO AVENUE
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-750-0444
Practice Address - Fax:787-750-0195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11366OtherSTATE LICENSE
PRBV4042254OtherFEDERAL NARCOTIC LICENSE
PR11036-1OtherSTATE NARCOTIC LICENSE
PRBV4042254OtherFEDERAL NARCOTIC LICENSE