Provider Demographics
NPI:1508898701
Name:RODRIGUEZ VELAZQUEZ, CARLOS E III (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:RODRIGUEZ VELAZQUEZ
Suffix:III
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 157
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720
Mailing Address - Country:US
Mailing Address - Phone:787-867-8085
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE LUIS M ALFARO
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-4467
Practice Address - Country:US
Practice Address - Phone:787-867-8085
Practice Address - Fax:787-867-8085
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12067208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41019Medicare UPIN
88823Medicare ID - Type Unspecified