MEDICARE: LIZAMARIE CABAN 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	208D00000X	General Practice Physician	17739	PR

General Provider Information

NPI Number	:	1356270805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZAMARIE CABAN VELAZQUEZ

Provider Business Mailing Address
First Line	:	567 AVE INTERAMERICANA
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-7390
Country	:	US
Telephone Number	:	939-339-4820
Fax Number	:

Provider Business Practice Location Address
First Line	:	567 AVE INTERAMERICANA
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-7390
Country	:	US
Telephone Number	:	939-339-4820
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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