| Doctor Name: | DR. LUIS J. VELAZQUEZ VICENTE |
| NPI Number: | 1891945580 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 17355 |
| Business Practice Address: | 4120 Us Highway 98 N Suite 400 Lakeland, FL - 33805 |
| Business Phone Number: | 8639403147 |
| Business Fax Number: | 8639403141 |
| Mailing Address: | 111 Webb Dr, DAVENPORT |
| State: | FL |
| Postal Code: | 338373962 |
| Phone Number: | 8635881424 |
| Fax Number: | 8889721752 |
| NPI Enumeration Date: | 09/30/2008 |
| NPI Last Update Date: | 11/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 17355 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |