Provider Demographics
NPI:1013918168
Name:RUBEN A. VELAZQUEZ ROUSSET, C.S.P.
Entity Type:Organization
Organization Name:RUBEN A. VELAZQUEZ ROUSSET, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VELAZQUEZ ROUSSET
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:787-832-4773
Mailing Address - Street 1:351 AVE HOSTOS
Mailing Address - Street 2:MEDICAL EMPORIUM SUITE 201
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1502
Mailing Address - Country:US
Mailing Address - Phone:787-832-4773
Mailing Address - Fax:787-986-6666
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM SUITE 201
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-832-4773
Practice Address - Fax:787-986-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15369207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty