Provider Demographics
NPI:1982728606
Name:DR JORGE A VELAZQUEZ Y ASOCIADOS
Entity type:Organization
Organization Name:DR JORGE A VELAZQUEZ Y ASOCIADOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:VELAZQUEZ RAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-753-4232
Mailing Address - Street 1:PO BOX 51516
Mailing Address - Street 2:PO BOX 51516
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1516
Mailing Address - Country:US
Mailing Address - Phone:787-753-4232
Mailing Address - Fax:787-753-8738
Practice Address - Street 1:70 CALLE GEORGETTI
Practice Address - Street 2:70 CALLE GEORGETTI
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3607
Practice Address - Country:US
Practice Address - Phone:787-753-4232
Practice Address - Fax:787-753-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04501223G0001X
PR23771223G0001X
PR22371223G0001X
PR09081223G0001X
PR19471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1114006079Medicare UPIN
PR1891850368Medicare UPIN
PR1083642029Medicare UPIN
PR1467548990Medicare UPIN
PR1871544908Medicare UPIN