Healthcare Provider Details

I. General information

NPI: 1750498085
Provider Name (Legal Business Name): MARIO O VELEZ GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 65 DE INFANTERIA #57
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 1410 65 DE INFANTERIA #57
ANASCO PR
00610
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-3666
  • Fax: 787-826-3666
Mailing address:
  • Phone: 787-826-3666
  • Fax: 787-826-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number10038
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10038
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: