Healthcare Provider Details

I. General information

NPI: 1669953196
Provider Name (Legal Business Name): IVANISSE ORTIZ VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 172 KM 0.2, URB. TURABO GARDENS SALIDA 21
CAGUAS PR
00725-3934
US

IV. Provider business mailing address

PO BOX 191267
SAN JUAN PR
00919-1267
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number22763
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: