Basic Information
| Provider Information | |||||||||
| NPI: | 1689208274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELAZQUEZ-LUCENA | ||||||||
| FirstName: | DERICK | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 S HARBOUR ISLAND BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336025925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273223439 | ||||||||
| FaxNumber: | 8009287449 | ||||||||
| Practice Location | |||||||||
| Address1: | 11317 LAKE UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328254435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074995900 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2020 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | NJDCATEMP-012231 | NJ | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 21618 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 475 | MA | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | 13873-I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 14128-I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | ACN1231 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.