Healthcare Provider Details

I. General information

NPI: 1154395556
Provider Name (Legal Business Name): LOUIS A VELAZQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11641 KEW GARDENS AVE STE 209
PALM BEACH GARDENS FL
33410-2846
US

IV. Provider business mailing address

11641 KEW GARDENS AVE STE 209
PALM BEACH GARDENS FL
33410-2846
US

V. Phone/Fax

Practice location:
  • Phone: 561-402-3971
  • Fax:
Mailing address:
  • Phone: 561-402-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number204120
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: