Provider Demographics
NPI:1629229901
Name:RICARDO VELAZQUEZ MD PLLC
Entity Type:Organization
Organization Name:RICARDO VELAZQUEZ MD PLLC
Other - Org Name:NEW HORIZONS PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-399-8808
Mailing Address - Street 1:PO BOX 750669
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-0669
Mailing Address - Country:US
Mailing Address - Phone:702-399-8808
Mailing Address - Fax:702-384-8807
Practice Address - Street 1:2010 GOLDRING AVE STE 308
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4099
Practice Address - Country:US
Practice Address - Phone:702-399-8808
Practice Address - Fax:702-384-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVBM373AMedicare PIN