Provider Demographics
NPI:1881007359
Name:VELAZQUEZ, JOSE MIGUEL
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MIGUEL
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 1:223 CALLE JACAGUAZ
Mailing Address - Street 2:PROVINCIAS DEL RIO II
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4945
Mailing Address - Country:US
Mailing Address - Phone:939-273-9818
Mailing Address - Fax:
Practice Address - Street 1:223 CALLE JACAGUAZ
Practice Address - Street 2:223 JACAGUAZ
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-4945
Practice Address - Country:US
Practice Address - Phone:939-273-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2214593172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver