Provider Demographics
NPI:1942477823
Name:VELASQUEZ, JUAN CAMILO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CAMILO
Last Name:VELASQUEZ
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 1:3001 NW 49TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7266
Mailing Address - Country:US
Mailing Address - Phone:954-714-0686
Mailing Address - Fax:954-731-6017
Practice Address - Street 1:3001 NW 49TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7266
Practice Address - Country:US
Practice Address - Phone:954-714-0686
Practice Address - Fax:954-731-6017
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121303207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology