Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 000670 | CT |
Y | 213ES0000X | Sports Medicine | 000670 | CT |
N | 2081S0010X | Sports Medicine | N004823 | NY |
N | 213ES0000X | Sports Medicine | N004823 | NY |
NPI | 1114934874 |
---|---|
Provider Name | Josephine Velazquez |
First Address | Darien, CT 06820-4521 |
Second Address | Darien, CT 06820-4521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RS178 | OXFORD INSURANCE ID # (01) | CT |
U16396 | (02) |