Healthcare Provider Details

I. General information

NPI: 1811618077
Provider Name (Legal Business Name): SV GASTROENTEROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 FERNANDEZ JUNCOS AVENUE EDIFICIO JESUS T PINEIRO
CAROLINA PR
00979-0001
US

IV. Provider business mailing address

URB. OLYMPIC COURT 153-A4 CALLE ANTIOQUIA
LAS PIEDRAS PR
00771-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-626-3322
  • Fax: 787-626-0472
Mailing address:
  • Phone: 787-475-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE JANICE VELAZQUEZ
Title or Position: SOLE OWNER
Credential: MD
Phone: 787-475-0388