Provider Demographics
NPI:1962567248
Name:VELAZQUEZ VALLE, MIGUEL ALI (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ALI
Last Name:VELAZQUEZ VALLE
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:H7 CALLE CAOBA
Mailing Address - Street 2:MANSIONES COLINAS DE CUPEY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7554
Mailing Address - Country:US
Mailing Address - Phone:787-946-0072
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN ANTONIO FINAL #941 SALIDA BARRIO JAGUAS
Practice Address - Street 2:GURABO COMMUNITY HEALTH CENTER
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-2377
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14177207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH98405Medicare UPIN
PR2-1793Medicare ID - Type Unspecified