Provider Demographics
NPI:1306956610
Name:VELAZQUEZ-VILLANUEVA, MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:VELAZQUEZ-VILLANUEVA
Suffix:
Gender:M
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 19418
Mailing Address - Street 2:FERNANDEZ JUNCOS STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1418
Mailing Address - Country:US
Mailing Address - Phone:787-720-1414
Mailing Address - Fax:787-287-8811
Practice Address - Street 1:140 AVE LAS CUMBRES SUITE 202
Practice Address - Street 2:GUAYNABO MEDICAL MALL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-0000
Practice Address - Country:US
Practice Address - Phone:787-720-1414
Practice Address - Fax:787-287-8811
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12470207V00000X
NY2114641207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H07336Medicare UPIN
0080284Medicare ID - Type Unspecified