Provider Demographics
NPI:1780628305
Name:VELAZQUEZ, ANGEL MANUEL (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MANUEL
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7438
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7438
Mailing Address - Country:US
Mailing Address - Phone:787-744-4399
Mailing Address - Fax:787-744-4399
Practice Address - Street 1:AVE. MUNOZ MARIN AVE.
Practice Address - Street 2:O-24 URB. VILLA CARMEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-4399
Practice Address - Fax:787-744-4399
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PR8516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8516OtherSTATE LICENSE