Provider Demographics
NPI:1184600892
Name:VELEZ-BALAY, JACQUES JUAN
Entity type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:JUAN
Last Name:VELEZ-BALAY
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 1:2401 HAWKINS POINT RD
Mailing Address - Street 2:
Mailing Address - City:CURTIS BAY
Mailing Address - State:MD
Mailing Address - Zip Code:21226-1797
Mailing Address - Country:US
Mailing Address - Phone:410-636-3702
Mailing Address - Fax:410-636-7686
Practice Address - Street 1:2401 HAWKINS POINT RD
Practice Address - Street 2:
Practice Address - City:CURTIS BAY
Practice Address - State:MD
Practice Address - Zip Code:21226-1797
Practice Address - Country:US
Practice Address - Phone:410-636-3702
Practice Address - Fax:410-636-7686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider