Provider Demographics
NPI:1962195594
Name:MORENOVELEZ, JOSE DAVID
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DAVID
Last Name:MORENOVELEZ
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 1:9781 GUNSTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-1528
Mailing Address - Country:US
Mailing Address - Phone:646-498-4546
Mailing Address - Fax:
Practice Address - Street 1:9781 GUNSTON RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-1528
Practice Address - Country:US
Practice Address - Phone:646-498-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No171000000XOther Service ProvidersMilitary Health Care Provider