Provider Demographics
NPI:1821335266
Name:VELAZQUEZ, EMANUEL SR (AD)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:VELAZQUEZ
Suffix:SR
Gender:M
Credentials:AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ORGUIDEA #60A BUZON 671
Mailing Address - Street 2:BUENAVENTURA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-364-7731
Mailing Address - Fax:
Practice Address - Street 1:CALLE ORGUIDEA #60A 671
Practice Address - Street 2:BUENAVENTURA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-364-7731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR586156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist