Healthcare Provider Details

I. General information

NPI: 1124377064
Provider Name (Legal Business Name): ALEX HERNAN VELASQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST STE 510
MIAMI FL
33125-1659
US

IV. Provider business mailing address

1321 NW 14TH ST STE 510
MIAMI FL
33125-1659
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5554
  • Fax: 305-243-5565
Mailing address:
  • Phone: 305-243-5554
  • Fax: 305-243-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP6543
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME140181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: