Provider Demographics
NPI:1205854569
Name:VELAZQUEZ RODRIGUEZ, JOHN N (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:VELAZQUEZ RODRIGUEZ
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:TORRE SAN PABLO DEL ESTE
Mailing Address - Street 2:410 AVE GENERAL VALERO
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3949
Mailing Address - Country:US
Mailing Address - Phone:787-585-3997
Mailing Address - Fax:787-203-5029
Practice Address - Street 1:404 AVE GENERAL VALERO
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3998
Practice Address - Country:US
Practice Address - Phone:787-585-3997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15213208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022588Medicare ID - Type UnspecifiedGENERAL MEDICIN