Healthcare Provider Details

I. General information

NPI: 1215959721
Provider Name (Legal Business Name): DIEGO VELARDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 SUNTREE BLVD STE 101
ROCKLEDGE FL
32955-5720
US

IV. Provider business mailing address

3165 SUNTREE BLVD STE 101
ROCKLEDGE FL
32955-5720
US

V. Phone/Fax

Practice location:
  • Phone: 321-549-2000
  • Fax: 321-549-2142
Mailing address:
  • Phone: 321-549-2000
  • Fax: 321-549-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberME94651
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME94651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: