Basic Information
Provider Information
NPI: 1467627729
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VELOZ
FirstName: WILLIAM
MiddleName: OMAR
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9755 NW 52ND ST APT 309
Address2:  
City: DORAL
State: FL
PostalCode: 331782074
CountryCode: US
TelephoneNumber: 3235744172
FaxNumber:  
Practice Location
Address1: 3501 JOHNSON ST
Address2:  
City: HOLLYWOOD
State: FL
PostalCode: 330215421
CountryCode: US
TelephoneNumber: 9549872000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/28/2008
LastUpdateDate: 04/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XME 112443FLY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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