Provider Demographics
NPI:1396902839
Name:VELAZQUEZ-CECENA, JOSE-LUIS ESTEBAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE-LUIS
Middle Name:ESTEBAN
Last Name:VELAZQUEZ-CECENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4901 RONDA ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1731
Mailing Address - Country:US
Mailing Address - Phone:305-905-2125
Mailing Address - Fax:305-256-5197
Practice Address - Street 1:9380 SW 150TH ST STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7979
Practice Address - Country:US
Practice Address - Phone:305-256-5018
Practice Address - Fax:305-256-5197
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101246310207RC0000X
KY42453207RC0000X
IL036-109951207RC0000X
FLME119572207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100067180Medicaid
KY7100067180Medicaid