MEDICARE: ADLINE M HORTA 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	207Q00000X	Family Medicine Physician	ACN503	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679654727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADLINE M HORTA VELAZQUEZ MD

Provider Business Mailing Address
First Line	:	1140 S SEMORAN BLVD
Second Line	:	SUITE
City	:	ORLANDO
State	:	FL
Zip	:	32807-1459
Country	:	US
Telephone Number	:	407-384-9165
Fax Number	:	407-384-9174

Provider Business Practice Location Address
First Line	:	1140 S SEMORAN BLVD
Second Line	:	SUITE E
City	:	ORLANDO
State	:	FL
Zip	:	32807-1459
Country	:	US
Telephone Number	:	407-384-9165
Fax Number	:	407-384-9174

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/07/2023

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