Healthcare Provider Details

I. General information

NPI: 1114378874
Provider Name (Legal Business Name): LUIS VELAZQUEZ MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 S HUALAPAI WAY STE 200
LAS VEGAS NV
89147-5734
US

IV. Provider business mailing address

1815 E LAKE MEAD BLVD STE 300
N LAS VEGAS NV
89030-7193
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-4150
  • Fax: 702-960-4154
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14692
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number14642
License Number StateNV

VIII. Authorized Official

Name: DR. LUIS VELAZQUEZ
Title or Position: PHYSICIAN OWNER/MANAGER
Credential: M.D.
Phone: 305-924-5198