=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437850336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOISES DAVID VELIZ IDMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2023
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12910 MARIDELL PARK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78253-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-442-1934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PSC 78 BOX 6672
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AP
-----------------------------------------------------
Zip | 96326-0067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-442-1934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1710I1003X
-----------------------------------------------------
Taxonomy Name | Independent Duty Medical Technicians
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------