=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679636633
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR A VELAZQUEZ CAUSSADE SR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 CALLE RAMON VALDES
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-831-1703
-----------------------------------------------------
Fax | 787-831-1766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3623 MARINA STA
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-831-1703
-----------------------------------------------------
Fax | 787-831-1766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 10903
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------