Basic Information
| Provider Information | |||||||||
| NPI: | 1235357807 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELASQUEZ | ||||||||
| FirstName: | MARITES | ||||||||
| MiddleName: | HIDALGO | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP,BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 LAKE WORTH RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334633213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619667717 | ||||||||
| FaxNumber: | 8883162198 | ||||||||
| Practice Location | |||||||||
| Address1: | 13005 SOUTHERN BLVD STE 121 | ||||||||
| Address2: | |||||||||
| City: | LOXAHATCHEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334709231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614443887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9167692 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.