Healthcare Provider Details

I. General information

NPI: 1487710463
Provider Name (Legal Business Name): JUAN MIGUEL GONZALEZ VELEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 7 BOX 0132
SAN FRANCISCO CA
94158-2549
US

IV. Provider business mailing address

351 KING ST UNIT 535
SAN FRANCISCO CA
94158-1627
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-9399
  • Fax: 415-476-1811
Mailing address:
  • Phone: 267-207-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMT180622
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301095334
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA 121943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: