Provider Demographics
NPI:1972334902
Name:VELASQUEZ, JAIME ERNESTO
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ERNESTO
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:ERNESTO
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SA-C
Mailing Address - Street 1:3127 NW 84TH WAY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-8907
Mailing Address - Country:US
Mailing Address - Phone:754-204-5232
Mailing Address - Fax:
Practice Address - Street 1:2820 NE 214TH ST STE 824
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1270
Practice Address - Country:US
Practice Address - Phone:754-204-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-661246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant