Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME71177 | FL |
NPI | 1023196052 |
---|---|
Provider Name | Kenneth O Cintron Velazquez |
First Address | Jacksonville, FL 32216-8070 |
Second Address | Jacksonville, FL 32256-5003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 25/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G11969 | (02) | PR |