Individual provider Active NPI

Andres Rene Velazquez, P.A.

  • Medical Physician Assistant
  • Miami, FL
National Provider Identifier
1104488113
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PACN110 Issued in FL
Practice address
330 SW 27TH Ave Ste 404
Miami, FL 33135-2967
Phone
(305) 926-9642
NPI assigned
Jul 1, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X PACN110 FL Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X TPPA966 FL
Physician Assistant 363A00000X 000260-P.A. PR

Addresses

Primary practice location

330 SW 27TH Ave Ste 404
Miami, FL 33135-2967

Mailing address

11230 SW 40TH Ter
Miami, FL 33165-4602
Phone (305) 926-9642

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
000260-P.A.PRMDPhysician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1104488113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11230 SW 40TH TER",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331654602",
            "telephone_number": "305-926-9642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 SW 27TH AVE STE 404",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331352967",
            "telephone_number": "305-926-9642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELAZQUEZ",
        "first_name": "ANDRES",
        "middle_name": "RENE",
        "name_prefix": "Dr.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-01",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PACN110",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "TPPA966",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "000260-P.A.",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.