Provider Demographics
NPI:1720344054
Name:VELAZCO, TANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:VELAZCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:FERNANDEZ LOZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:508 PUMPKIN DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5543
Mailing Address - Country:US
Mailing Address - Phone:254-780-9538
Mailing Address - Fax:
Practice Address - Street 1:1901 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-778-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043162207R00000X
KY49304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine