MEDICARE: DR. MANUEL VELILLA IGLESIAS M.D.

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	207V00000X	Obstetrics & Gynecology Physician	5373	PR

General Provider Information

NPI Number	:	1861461261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL VELILLA IGLESIAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 362318
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-2318
Country	:	US
Telephone Number	:	787-728-8338
Fax Number	:	787-727-0507

Provider Business Practice Location Address
First Line	:	252 CALLE SAN JORGE
Second Line	:	SAN JORGE MEDICAL BUILDING, SUITE 405
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3239
Country	:	US
Telephone Number	:	787-728-8338
Fax Number	:	787-727-0507

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	10/24/2011

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