Provider Demographics
NPI:1619930021
Name:VELAZQUEZ, MARITZA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:A
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8600 SW 92ND ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7377
Mailing Address - Country:US
Mailing Address - Phone:305-598-4499
Mailing Address - Fax:305-598-3426
Practice Address - Street 1:8600 SW 92ND ST
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7377
Practice Address - Country:US
Practice Address - Phone:305-598-4499
Practice Address - Fax:305-598-3426
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0055887208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1398900Medicaid
FL1398900Medicaid
FL1398900Medicaid