Healthcare Provider Details

I. General information

NPI: 1649953100
Provider Name (Legal Business Name): JAVIER JURADO VELEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 20TH ST S
BIRMINGHAM AL
35205-2610
US

IV. Provider business mailing address

169 ASHLEY AVE
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 205-480-4852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMMD.97417LL
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: