Provider Demographics
NPI:1447522438
Name:VELAZQUEZ, JUAN MARCOS (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MARCOS
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:167 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2211
Mailing Address - Country:US
Mailing Address - Phone:305-823-3312
Mailing Address - Fax:305-884-3989
Practice Address - Street 1:20595 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2456
Practice Address - Country:US
Practice Address - Phone:305-823-3312
Practice Address - Fax:305-884-3989
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine