Provider Demographics
NPI:1285619536
Name:VELAZQUEZ, ELBA (MD)
Entity type:Individual
Prefix:DR
First Name:ELBA
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0068
Mailing Address - Country:US
Mailing Address - Phone:787-836-8522
Mailing Address - Fax:
Practice Address - Street 1:959 CALLE MUNOZ RIVERA
Practice Address - Street 2:MUNOZ RIVERA 959
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-2022
Practice Address - Country:US
Practice Address - Phone:787-836-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10420208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice