Healthcare Provider Details

I. General information

NPI: 1215520341
Provider Name (Legal Business Name): JOSUE RENE ROSARIO VELAZQUEZ BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 E SEMORAN BLVD
APOPKA FL
32703-5805
US

IV. Provider business mailing address

2438 E SEMORAN BLVD
APOPKA FL
32703-5805
US

V. Phone/Fax

Practice location:
  • Phone: 407-703-5968
  • Fax:
Mailing address:
  • Phone: 407-703-5968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: