Provider Demographics
NPI:1184241929
Name:MORA VELAZQUEZ, ADIN MATTHEW JR
Entity type:Individual
Prefix:
First Name:ADIN MATTHEW
Middle Name:
Last Name:MORA VELAZQUEZ
Suffix:JR
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 1:2302 S JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-5102
Mailing Address - Country:US
Mailing Address - Phone:808-315-3031
Mailing Address - Fax:
Practice Address - Street 1:2302 S JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-5102
Practice Address - Country:US
Practice Address - Phone:808-315-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion