Provider Demographics
NPI:1154382133
Name:VELAZQUEZ, MERCEDES (MD)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 EDUARDO CONDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912
Mailing Address - Country:US
Mailing Address - Phone:787-292-1490
Mailing Address - Fax:787-293-0065
Practice Address - Street 1:CARR. 844 KM.O.9 CAMINO LOS PIZARROS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5230
Practice Address - Country:US
Practice Address - Phone:787-292-1490
Practice Address - Fax:787-293-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR092222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96977Medicare UPIN
0084317Medicare ID - Type Unspecified