Provider Demographics
NPI:1336215573
Name:VELASCO, ALEJANDRO M (MT)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:M
Last Name:VELASCO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ESSEX CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7943
Mailing Address - Country:US
Mailing Address - Phone:937-423-1644
Mailing Address - Fax:
Practice Address - Street 1:41 ESSEX CT
Practice Address - Street 2:SUITE B
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7943
Practice Address - Country:US
Practice Address - Phone:937-423-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA36049208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA36049OtherLICENSE