Provider Demographics
NPI:1720290083
Name:VELAZQUEZ-ROUSSET, RUBEN ANTONIO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:ANTONIO
Last Name:VELAZQUEZ-ROUSSET
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3210
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3210
Mailing Address - Country:US
Mailing Address - Phone:787-832-4773
Mailing Address - Fax:787-986-6666
Practice Address - Street 1:CARR 349 KM 2.7
Practice Address - Street 2:BELLA VISTA HOSPITAL
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-4773
Practice Address - Fax:787-986-6666
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15369207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-43824Medicare UPIN