Organization
HIALEAH DERMATOLOGY AND COSMETIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NELSON EDDIE VELAZQUEZ DO (PRESIDENT)
(305) 822-0678
Entity
Organization
Contact information
Practice address
7000 W 12TH AVE, SUITE#4, HIALEAH, FL 33014-5154
(305) 822-0678
(305) 822-0698
Mailing address
7000 W 12TH AVE, SUITE#4, HIALEAH, FL 33014-5154
(305) 822-0678
(305) 822-0698
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
OS6127
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600471-7
OCCUPATIONAL LICENSE
FL
01
—
OS6127
MEDICAL LICENSE NUMBER
FL
Enumeration date
10/12/2006
Last updated
03/07/2023
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