Provider Demographics
NPI:1417111717
Name:VELEZ, LUZ ANGELA (SAC)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:ANGELA
Last Name:VELEZ
Suffix:
Gender:F
Credentials:SAC
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 650990
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-0990
Mailing Address - Country:US
Mailing Address - Phone:305-223-3000
Mailing Address - Fax:305-228-5435
Practice Address - Street 1:11750 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3530
Practice Address - Country:US
Practice Address - Phone:305-223-3000
Practice Address - Fax:305-228-5435
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07233246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07233OtherAMERICAN BOARD OF SURGICAL ASSISTANTS