MEDICARE: PEDRO VELAZQUEZ

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	310400000X	Assisted Living Facility	12938	FL

General Provider Information

NPI Number	:	1326581836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO VELAZQUEZ

Provider Business Mailing Address
First Line	:	2307 W SAINT JOSEPH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1651
Country	:	US
Telephone Number	:	813-468-4890
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 W SAINT JOSEPH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1651
Country	:	US
Telephone Number	:	813-468-4890
Fax Number	:

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

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/01/2016

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Directions to “ PEDRO VELAZQUEZ ” Practice Location

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