Provider Demographics
NPI:1679636633
Name:VELAZQUEZ CAUSSADE, VICTOR A SR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:VELAZQUEZ CAUSSADE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3623 MARINA STA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681
Mailing Address - Country:US
Mailing Address - Phone:787-831-1703
Mailing Address - Fax:787-831-1766
Practice Address - Street 1:58 CALLE RAMON VALDES
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-1703
Practice Address - Fax:787-831-1766
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10903208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR01784OtherAMERICAN HEALTH MEDICARE
PR8453OtherFIRS PLUS MEDICARE
PR8453OtherINTERNATIONAL MED CARD
PR060292OtherLA CRUZ AZUL
PR2125OtherPREFERRED MEDICARE CHOICE
PR83675OtherTRIPLE S INC
PR01784OtherAMERICAN HEALTH
PR100258 WOtherMEDICARE Y MUCHO MAS
PR01784OtherAMERICAN HEALTH MEDICARE
PR060292OtherLA CRUZ AZUL