Provider Demographics
NPI:1427334036
Name:VELAZQUEZ, ANGEL (LPN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 E 18TH ST
Mailing Address - Street 2:3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5777
Mailing Address - Country:US
Mailing Address - Phone:718-941-4655
Mailing Address - Fax:718-941-4655
Practice Address - Street 1:385 E 18TH ST
Practice Address - Street 2:3F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5777
Practice Address - Country:US
Practice Address - Phone:718-941-4655
Practice Address - Fax:718-941-4655
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303779164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse