Provider Demographics
NPI:1437850336
Name:VELIZ, MOISES DAVID (IDMT)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:DAVID
Last Name:VELIZ
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 78 BOX 6672
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326-0067
Mailing Address - Country:US
Mailing Address - Phone:478-442-1934
Mailing Address - Fax:
Practice Address - Street 1:12910 MARIDELL PARK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-3422
Practice Address - Country:US
Practice Address - Phone:478-442-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical TechniciansGroup - Single Specialty