MEDICARE: GEMMA VELEZ

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	122300000X	Dentist	DN15336	FL

General Provider Information

NPI Number	:	1730436122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEMMA VELEZ

Provider Business Mailing Address
First Line	:	1231 BLACKWOOD AVE
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 BLACKWOOD AVE
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4521
Country	:	US
Telephone Number	:	407-654-2999
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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Directions to “ GEMMA VELEZ ” Practice Location

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