=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376857268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XIOMARA VELAZCO, M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2010
-----------------------------------------------------
Last Update Date | 08/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 NE STALLINGS DR. SUITE 1500
-----------------------------------------------------
City | NACOGDOCHES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75965-1207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-715-9470
-----------------------------------------------------
Fax | 936-715-9475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 NE STALLINGS DR. SUITE 1500
-----------------------------------------------------
City | NACOGDOCHES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75965-1207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-715-9470
-----------------------------------------------------
Fax | 936-715-9475
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | XIOMARA VELAZCO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 936-715-9470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | N6749
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------