Provider Demographics
NPI:1245228584
Name:VELASCO, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:VELASCO
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:PO BOX 6517
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6517
Mailing Address - Country:US
Mailing Address - Phone:787-831-8166
Mailing Address - Fax:787-805-2122
Practice Address - Street 1:CALLE MCKINLEY W # 114
Practice Address - Street 2:SUITE 207
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3988
Practice Address - Country:US
Practice Address - Phone:787-831-8166
Practice Address - Fax:787-805-2122
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8941174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF30645Medicare UPIN
PR0084847AMedicare PIN