Provider Demographics
NPI:1548313158
Name:VELAZ, FRANCISCO RAFAEL
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:RAFAEL
Last Name:VELAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NE 6TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1153
Mailing Address - Country:US
Mailing Address - Phone:954-249-9176
Mailing Address - Fax:
Practice Address - Street 1:4450 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33308-5112
Practice Address - Country:US
Practice Address - Phone:954-249-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist