Healthcare Provider Details

I. General information

NPI: 1689603946
Provider Name (Legal Business Name): MARIA ISABEL VELAZQUEZ-SALICRUP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO DE DIAGNOSTICO Y TRATAMIENTO ( CDT) CALLE BARCELO # 12
CIDRA PR
00739
US

IV. Provider business mailing address

URB. HILLSIDE A 11 CALLE 1
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-2059
  • Fax: 787-739-2059
Mailing address:
  • Phone: 787-373-1073
  • Fax: 787-373-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number04029
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: