Individual
JUAN HORACIO VELASQUEZ LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-2005
(601) 815-0434
Mailing address
910 SHERIDAN AVE APT 4A, BRONX, NY 10451-3330
(718) 926-9223
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
31029
MS
2080N0001X
Neonatal-Perinatal Medicine Physician
31029
MS
Other
Enumeration date
07/03/2017
Last updated
11/10/2023
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