Provider Demographics
NPI:1679116123
Name:VELAZQUEZ ESCUDERO, BRAULIO
Entity type:Individual
Prefix:
First Name:BRAULIO
Middle Name:
Last Name:VELAZQUEZ ESCUDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 VILLAS DE MONTERREY REXVILLE
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-478-9730
Mailing Address - Fax:
Practice Address - Street 1:CARR 167 KM 17.8
Practice Address - Street 2:BARRIO PAJAROS PUERTORRIQUENO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-3435
Practice Address - Fax:787-780-3435
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1294-2133V00000X
PR1305-2133V00000X
PR2127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered