Basic Information
| Provider Information | |||||||||
| NPI: | 1023105632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELEZ | ||||||||
| FirstName: | BAUDILIO | ||||||||
| MiddleName: | JOSE' | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26028 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052321617 | ||||||||
| FaxNumber: | 5052627729 | ||||||||
| Practice Location | |||||||||
| Address1: | 5150 JOURNAL CENTER BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871095900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052623212 | ||||||||
| FaxNumber: | 5052321532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CNP-03146 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | ARNP2742702 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP2300X | CNP-03146 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 13835220 | 05 | NM | MEDICAID | 30797088 | 05 | FL | MEDICAID | P00657716 | 01 | FL | MEDICARE RR | OTHER |