Provider Demographics
NPI:1669670543
Name:VELAZQUEZ, ECTIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ECTIS
Middle Name:A
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5955 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2423
Mailing Address - Country:US
Mailing Address - Phone:305-661-1515
Mailing Address - Fax:305-663-5948
Practice Address - Street 1:5955 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2423
Practice Address - Country:US
Practice Address - Phone:305-661-1515
Practice Address - Fax:305-663-5948
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2016-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME947032080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine