Provider Demographics
NPI:1104488113
Name:VELAZQUEZ, ANDRES RENE (PA)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:RENE
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:B9 CALLE 1A APT A
Mailing Address - Street 2:URB VILLAS DE LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:305-290-8975
Mailing Address - Fax:
Practice Address - Street 1:B9 CALLE 1A APT A
Practice Address - Street 2:URB VILLAS DE LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4257
Practice Address - Country:US
Practice Address - Phone:305-290-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR000260-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant