Basic Information
| Provider Information | |||||||||
| NPI: | 1164632717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELASQUEZ | ||||||||
| FirstName: | RAFAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | STE 305 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522775348 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 9555 SEMINOLE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337722522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273935428 | ||||||||
| FaxNumber: | 7273999037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L2694 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04-33895 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME119208 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.