Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN23907 | FL |
Y | 213EG0000X | General Practice | DN23907 | FL |
NPI | 1003467051 |
---|---|
Provider Name | Ivonne Velazquez |
First Address | Ocala, FL 34471-8262 |
Second Address | Ocala, FL 34471-8262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2019 |
Last Update Date | 20/09/2019 |