MEDICARE: MISS SUZETTE MARIE VELAZQUEZ RODRIGUEZ LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	1929	PR

General Provider Information

NPI Number	:	1235523390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SUZETTE MARIE VELAZQUEZ RODRIGUEZ LDN

Provider Business Mailing Address
First Line	:	4141 CALLE MARSELLA
Second Line	:	URB. PUNTO ORO
City	:	PONCE
State	:	PR
Zip	:	00728-2056
Country	:	US
Telephone Number	:	787-633-9870
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 CALLE MARSELLA
Second Line	:	URB. PUNTO ORO
City	:	PONCE
State	:	PR
Zip	:	00728-2056
Country	:	US
Telephone Number	:	787-633-9870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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