Provider Demographics
NPI:1790039352
Name:VELAZQUEZ, JOSE R
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
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:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0401
Mailing Address - Country:US
Mailing Address - Phone:787-678-8683
Mailing Address - Fax:
Practice Address - Street 1:1706 CALLE ORINOCO
Practice Address - Street 2:
Practice Address - City:CUPEY
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-678-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program