Provider Demographics
NPI:1265514558
Name:VELAZQUEZ MUNOZ, IVAN H (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:H
Last Name:VELAZQUEZ MUNOZ
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:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0674
Mailing Address - Country:US
Mailing Address - Phone:787-872-5860
Mailing Address - Fax:787-872-5860
Practice Address - Street 1:12 CALLE JESUS T PINERO SUITE 3
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0674
Practice Address - Country:US
Practice Address - Phone:787-872-5860
Practice Address - Fax:787-872-5860
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9959173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR069631OtherBLUE CROSS OF PR
PR201461OtherPREFERRED HEALTH
PR5386OtherFIRST MEDICAL
PR662084OtherHUMANA HEALTH
PR1754OtherAMERICAN HEALTH
PR82853OtherTRIPLE S
PR1309OtherPREFEREED MEDICARE CHOICE
PR1754OtherAMERICAN HEALTH