Provider Demographics
NPI:1659561017
Name:VELAZQUEZ, LIONEL
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CANOVANAS 305
Mailing Address - Street 2:VILLA PALMERAS
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00912
Mailing Address - Country:US
Mailing Address - Phone:939-628-7628
Mailing Address - Fax:
Practice Address - Street 1:COND. GOLDEN TOWER C-8
Practice Address - Street 2:AVE PONTEZUELA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-769-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2929183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician