Provider Demographics
NPI:1740404706
Name:VELAZQUEZ, PROVIANA ORTIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PROVIANA
Middle Name:ORTIZ
Last Name:VELAZQUEZ
Suffix:
Gender:F
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:C33 CALLE 3
Mailing Address - Street 2:HILL SIDE
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5205
Mailing Address - Country:US
Mailing Address - Phone:787-879-1585
Mailing Address - Fax:787-879-4315
Practice Address - Street 1:V1 CALLE 16
Practice Address - Street 2:URB. VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3112
Practice Address - Country:US
Practice Address - Phone:787-879-1585
Practice Address - Fax:787-879-4315
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6342208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97928OtherPROVIDER SSS