Provider Demographics
NPI:1518925288
Name:VELAZQUEZ, MARCOS A (MD)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:A
Last Name: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 1497
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1497
Mailing Address - Country:US
Mailing Address - Phone:787-833-6100
Mailing Address - Fax:787-833-5980
Practice Address - Street 1:CALLE DE DIEGO #55
Practice Address - Street 2:EDIFICIO CPR SUITE 303-304
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00668
Practice Address - Country:US
Practice Address - Phone:787-833-6100
Practice Address - Fax:787-833-5980
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7697207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
80461Medicare ID - Type Unspecified
E66543Medicare UPIN