Healthcare Provider Details

I. General information

NPI: 1326361908
Provider Name (Legal Business Name): MVP REHABILITATION SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO MEDICO HERMANAS DAVILA OFICINA #206 EXTENSION VILLA RICA
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 2025
BAYAMON PR
00960-2025
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-5151
  • Fax:
Mailing address:
  • Phone: 787-642-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number16191
License Number StatePR

VIII. Authorized Official

Name: MANUEL ANTONIO VELEZ PEREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-642-1868