MEDICARE: MR. FRANCISCO RAFAEL VELAZ

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	174400000X	Specialist	MA32984	FL

General Provider Information

NPI Number	:	1548313158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANCISCO RAFAEL VELAZ

Provider Business Mailing Address
First Line	:	2300 NE 6TH AVE APT 101
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33305-1153
Country	:	US
Telephone Number	:	954-249-9176
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 NE 20TH AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33308-5112
Country	:	US
Telephone Number	:	954-249-9176
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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