Provider Demographics
NPI:1225315559
Name:VELAZQUEZ, CARLOS R
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SW 27TH AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2961
Mailing Address - Country:US
Mailing Address - Phone:305-640-8936
Mailing Address - Fax:305-640-5923
Practice Address - Street 1:330 SW 27TH AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2961
Practice Address - Country:US
Practice Address - Phone:305-640-8936
Practice Address - Fax:305-640-5923
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61457225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist