Provider Demographics
NPI:1447287735
Name:VELAZQUEZ, OMAIDA C (MD)
Entity type:Individual
Prefix:
First Name:OMAIDA
Middle Name:C
Last Name: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 1:1611 NW 12TH AVE FL CTR4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-6000
Mailing Address - Fax:305-585-8569
Practice Address - Street 1:1611 NW 12TH AVE FL CTR4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-6000
Practice Address - Fax:305-585-8569
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054213L2086S0129X
FLME1000872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017492560001Medicaid
FL2798522-00Medicaid
FLAG757ZMedicare PIN
FL027017Medicare UPIN
G92645Medicare UPIN