Provider Demographics
NPI:1609630540
Name:VELEZ QUEZADA, LORENA ANTONELLA (MB)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:ANTONELLA
Last Name:VELEZ QUEZADA
Suffix:
Gender:F
Credentials:MB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 98TH ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1428
Mailing Address - Country:US
Mailing Address - Phone:862-237-8954
Mailing Address - Fax:
Practice Address - Street 1:327 BEACH 19TH STREET
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty