Provider Demographics
NPI:1811102163
Name:VELAZQUEZ RIVERA, JOSE T (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:T
Last Name:VELAZQUEZ RIVERA
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:ROAD # 444, KM 1.9
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0398
Mailing Address - Country:US
Mailing Address - Phone:787-630-3526
Mailing Address - Fax:787-877-3223
Practice Address - Street 1:ROAD # 444, KM 1.9
Practice Address - Street 2:BO. CUCHILLAS
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0398
Practice Address - Country:US
Practice Address - Phone:787-630-3526
Practice Address - Fax:787-877-3223
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28672083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine