Provider Demographics
NPI:1114901162
Name:VELAZQUEZ, BENJAMIN RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RICARDO
Last Name:VELAZQUEZ
Suffix:
Gender:M
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:CALLE 7 #132
Mailing Address - Street 2:SANTA ISIDRA II
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-801-7710
Mailing Address - Fax:787-801-7710
Practice Address - Street 1:AVE PRINCIPAL G 19 URB BARALT
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-7710
Practice Address - Fax:787-801-7710
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14595208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
21242VEOtherTRIPLE SSS
7380071OtherHUMANA
7380071OtherHUMANA