Healthcare Provider Details

I. General information

NPI: 1811557523
Provider Name (Legal Business Name): LUIS R VELAZQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N STE 304
BOCA RATON FL
33428-2237
US

IV. Provider business mailing address

8520 SW 149TH AVE APT 1015
MIAMI FL
33193-1446
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-6611
  • Fax:
Mailing address:
  • Phone: 786-609-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME181730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: