Provider Demographics
NPI:1457569667
Name:VELAZQUEZ, WANDA I
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:I
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CALLE 2C
Mailing Address - Street 2:URB. JOSE SEVERA QUINONES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5923
Mailing Address - Country:US
Mailing Address - Phone:787-752-1914
Mailing Address - Fax:
Practice Address - Street 1:713 CALLE 2C
Practice Address - Street 2:URB. JOSE SEVERO QUINONES
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5923
Practice Address - Country:US
Practice Address - Phone:787-257-4320
Practice Address - Fax:787-257-4320
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1742183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician