Provider Demographics
NPI:1306982731
Name:VELAZQUEZ, EDGARDO
Entity type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CALLE SOLDADO ALCIDES REYES
Mailing Address - Street 2:SAN AGUSTIN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3214
Mailing Address - Country:US
Mailing Address - Phone:787-533-3818
Mailing Address - Fax:
Practice Address - Street 1:411 CALLE SOLDADO ALCIDES REYES
Practice Address - Street 2:SAN AGUSTIN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3214
Practice Address - Country:US
Practice Address - Phone:787-533-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 415341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance