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NPI Code Detail

MEDICARE: DR. MARISSEL VELAZQUEZ VICENTE MD

MEDICARE: DR. MARISSEL VELAZQUEZ VICENTE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianME135986FL
2207RP1001XPulmonary Disease Physician35.136627OH
3207RP1001XPulmonary Disease PhysicianME135986FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17327OTHERPRSTATE MD LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396931275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARISSEL VELAZQUEZ VICENTE MD
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 941-357-7950
Fax Number : 941-840-1003
Provider Business Practice Location Address
First Line : 1505 53RD AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34203-4249
Country : US
Telephone Number : 941-357-7950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2007
Last Update Date : 03/19/2021

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