Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 57260 | TN |
N | 2080P0207X | Pediatric Hematology-Oncologist | Q1322 | TX |
NPI | 1235438698 |
---|---|
Provider Name | Mireya Paulina Velasquez |
First Address | Houston, TX 77030-2613 |
Second Address | Memphis, TN 38105-3678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 29/07/2020 |