Healthcare Provider Details

I. General information

NPI: 1790447035
Provider Name (Legal Business Name): SEBASTIAN RODRIGUEZ VELEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO COMERCIAL LOCAL 1 URB. CATALANA #66
BARCELONETA PR
00617-0061
US

IV. Provider business mailing address

10 CALLE CABAN
CAMUY PR
00627-2318
US

V. Phone/Fax

Practice location:
  • Phone: 787-915-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1341
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6747517
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerDRIVERS LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: