Healthcare Provider Details

I. General information

NPI: 1376460881
Provider Name (Legal Business Name): CARLA MASSIEL VELEZ MENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2594
US

IV. Provider business mailing address

4422 3RD AVE
BRONX NY
10457-2594
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6202
  • Fax: 718-960-3218
Mailing address:
  • Phone: 718-960-6202
  • Fax: 718-960-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: