Healthcare Provider Details

I. General information

NPI: 1689675613
Provider Name (Legal Business Name): ANGEL GILBERTO VELEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 JOSE C. VAZQUEZ
AIBONITO PR
00705
US

IV. Provider business mailing address

P.O. BOX 1573
AIBONITO PR
00705-1573
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-1455
  • Fax: 787-991-1455
Mailing address:
  • Phone: 787-735-3425
  • Fax: 787-991-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10449
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: