Basic Information
| Provider Information | |||||||||
| NPI: | 1447789359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELAZQUEZ PEREZ | ||||||||
| FirstName: | FREYDA | ||||||||
| MiddleName: | LETICIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9650 E WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462293032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179628893 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2017 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 11019336A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 01084280A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.