MEDICARE: DR. ELBA VELAZQUEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	10420	PR

General Provider Information

NPI Number	:	1285619536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELBA VELAZQUEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624-0068
Country	:	US
Telephone Number	:	787-836-8522
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 CALLE MUNOZ RIVERA
Second Line	:	MUNOZ RIVERA 959
City	:	PENUELAS
State	:	PR
Zip	:	00624-2022
Country	:	US
Telephone Number	:	787-836-7603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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