Provider Demographics
NPI:1609872829
Name:VELASQUEZ, MARIA VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VICTORIA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:951 NW 13TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-447-9341
Mailing Address - Fax:561-447-9352
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2304
Practice Address - Country:US
Practice Address - Phone:561-447-9341
Practice Address - Fax:561-447-9352
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME638772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252315900Medicaid
FL31462OtherBLUE CROSS BLUE SHIELD
FLP00121004OtherRAILROAD MEDICARE
FLP00121004OtherRAILROAD MEDICARE
FLG63243Medicare UPIN