Provider Demographics
NPI:1881755122
Name:VELAZQUEZ, GLORIMAR (MD)
Entity type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
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:PASEO LA PRINCESA APT 104
Mailing Address - Street 2:MONACO STREET BLDG 2105
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2232
Mailing Address - Country:US
Mailing Address - Phone:787-463-1535
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL DAMAS
Practice Address - Street 2:2213 PONCE BYPASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2232
Practice Address - Country:US
Practice Address - Phone:787-463-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRDM-15337-9207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI31050Medicare UPIN
PR0023015Medicare ID - Type Unspecified