Provider Demographics
NPI:1629068739
Name:VELAZQUEZ, WANDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:L
Last Name:VELAZQUEZ
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Gender:F
Credentials:MD
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Mailing Address - Street 1:RA9 VIA DEL RIO
Mailing Address - Street 2:RIO CRISTAL
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6021
Mailing Address - Country:US
Mailing Address - Phone:787-755-5475
Mailing Address - Fax:757-760-1420
Practice Address - Street 1:358 ALTOS SUENIDA JAN CLAUDIO
Practice Address - Street 2:SAGMA CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-761-6309
Practice Address - Fax:787-761-6309
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PR10692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics