Provider Demographics
NPI:1992703185
Name:HUERTAS VELAZQUEZ, ILIA I (MD)
Entity type:Individual
Prefix:DR
First Name:ILIA
Middle Name:I
Last Name:HUERTAS VELAZQUEZ
Suffix:
Gender:F
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:V2 CALLE 65
Mailing Address - Street 2:URB.BAIROA PARK
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1232
Mailing Address - Country:US
Mailing Address - Phone:787-662-0519
Mailing Address - Fax:787-662-0519
Practice Address - Street 1:AB1 CALLE REINA ISABEL
Practice Address - Street 2:AVE. BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1565
Practice Address - Country:US
Practice Address - Phone:787-662-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13588208D00000X
PR2544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2544OtherPHARMACIST
PR2544OtherPHARMACIST