Provider Demographics
NPI:1952600736
Name:DAVILA-VELAZQUEZ, JUAN JAVIER (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JAVIER
Last Name:DAVILA-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 1:3450 WAYNE AVE
Mailing Address - Street 2:APT 3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2510
Mailing Address - Country:US
Mailing Address - Phone:917-664-3932
Mailing Address - Fax:
Practice Address - Street 1:3450 WAYNE AVE
Practice Address - Street 2:APT 3B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2510
Practice Address - Country:US
Practice Address - Phone:917-664-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259823207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology