Provider Demographics
NPI:1710032628
Name:VELEZ-PESTANA, LUIS I (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:I
Last Name:VELEZ-PESTANA
Suffix:
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 535770
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5770
Mailing Address - Country:US
Mailing Address - Phone:866-507-5244
Mailing Address - Fax:954-858-1815
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-0000
Practice Address - Country:US
Practice Address - Phone:315-299-5451
Practice Address - Fax:855-851-4405
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4782207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145023103Medicaid
LA1820148Medicaid
TXP00394530OtherRAILROAD MEDICARE
LA1820148Medicaid
TX8D8525Medicare PIN