Provider Demographics
NPI:1376570499
Name:VELAZQUEZ LOZADA, IDIA LIZ (MD)
Entity Type:Individual
Prefix:
First Name:IDIA
Middle Name:LIZ
Last Name:VELAZQUEZ LOZADA
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:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1197
Mailing Address - Country:US
Mailing Address - Phone:787-852-3417
Mailing Address - Fax:
Practice Address - Street 1:AVE. FONT MARTELLO 123, EAST
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-0000
Practice Address - Country:US
Practice Address - Phone:787-852-3417
Practice Address - Fax:787-850-7861
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400273OtherMEDICARE Y MUCHO MAS
PR22381OtherTRIPLE S
PR7250313OtherHUMANA HEALTH PLAN
PRP851OtherFIRST MEDICAL
PR3548OtherPREFERRED MEDICARE CHOICE
PR100524OtherCRUZ AZUL DE PR
PR7250313OtherHUMANA INSURANCE
PR7250313OtherHUMANA INSURANCE
PR0022381Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER