Provider Demographics
NPI:1164909313
Name:VELAZCO, GILBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:VELAZCO
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 1:1321 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1673
Mailing Address - Country:US
Mailing Address - Phone:305-243-6692
Mailing Address - Fax:305-585-8655
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-243-6692
Practice Address - Fax:305-585-8655
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152349207R00000X
390200000X
PR14854-I390200000X
FL152349390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine