Basic Information
| Provider Information | |||||||||
| NPI: | 1811557523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELAZQUEZ | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | RENE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8520 SW 149TH AVE APT 1015 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331931446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866094460 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AVENIDA AMERICO MIRANDA | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009351446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2019 | ||||||||
| LastUpdateDate: | 07/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 14721-I | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | 34505R | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0003X | 35528-R | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.