Individual
JERARDY IVAN VELASQUEZ-BRAVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6180 UNIVERSITY PKWY UNIT 3905, FORT POLK, LA 71459-3118
(757) 709-5503
Mailing address
6180 UNIVERSITY PKWY UNIT 3905, FORT POLK, LA 71459-3118
(757) 709-5503
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
LA
Other
Enumeration date
07/15/2026
Last updated
07/15/2026
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