Provider Demographics
NPI:1437111820
Name:VELAZQUEZ-FELICIANO, FREDDIE ELIU (MD)
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:ELIU
Last Name:VELAZQUEZ-FELICIANO
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 1:114 JENGIBRE ST.
Mailing Address - Street 2:CIUDAD JARDIN GURABO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-447-4336
Mailing Address - Fax:787-712-9689
Practice Address - Street 1:#5 DUFRESNE ST.
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-656-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH68143Medicare UPIN