MEDICARE: MRS. WILMA A OLIVIERI VELEZ MT

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	291U00000X	Clinical Medical Laboratory	6462	PR

General Provider Information

NPI Number	:	1598128001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WILMA A OLIVIERI VELEZ MT

Provider Business Mailing Address
First Line	:	85 AVE UNIV INTERAMERICANA
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4343
Country	:	US
Telephone Number	:	787-892-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 AVE UNIV INTERAMERICANA
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4343
Country	:	US
Telephone Number	:	787-892-4651
Fax Number	:

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

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	04/01/2016

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