Healthcare Provider Details

I. General information

NPI: 1851883011
Provider Name (Legal Business Name): ROGER A VELASQUEZ MD MPH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 12/17/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 WEST AVE
SAN ANTONIO TX
78213-1817
US

IV. Provider business mailing address

110 LARKWOOD DR
SAN ANTONIO TX
78209-2908
US

V. Phone/Fax

Practice location:
  • Phone: 210-415-6931
  • Fax:
Mailing address:
  • Phone: 210-415-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberP9481
License Number StateTX

VIII. Authorized Official

Name: MRS. STEPHANIE VELASQUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 210-983-3937