Provider Demographics
NPI:1508846510
Name:ROQUE VELAZQUEZ, FELIX R (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:R
Last Name:ROQUE VELAZQUEZ
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 7318
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7318
Mailing Address - Country:US
Mailing Address - Phone:787-738-8083
Mailing Address - Fax:787-535-1030
Practice Address - Street 1:HOSPITAL MENONITA DE CAYEY
Practice Address - Street 2:EDIFICIO PROFESIONAL SUITE 412
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-2800
Practice Address - Country:US
Practice Address - Phone:787-738-8083
Practice Address - Fax:787-535-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13646208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH41547Medicare UPIN
PR20671Medicare PIN