MEDICARE: EDWILL BURGOS-VELAZQUEZ LCDO

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	133NN1002X	Nutrition Education Nutritionist	1897	PR

General Provider Information

NPI Number	:	1679963722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWILL BURGOS-VELAZQUEZ LCDO

Provider Business Mailing Address
First Line	:	PO BOX 83
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757
Country	:	US
Telephone Number	:	787-242-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 CALLE SEGUNDO BERNIER
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-3036
Country	:	US
Telephone Number	:	787-803-8221
Fax Number	:	787-537-7071

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

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	12/14/2021

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