Healthcare Provider Details

I. General information

NPI: 1871175372
Provider Name (Legal Business Name): MVP HEALTH & MEDICAL GROUP , LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 506 KM 1 TORRE SAN CRISTOBAL STE 209
COTO LAUREL PR
00780
US

IV. Provider business mailing address

CARRETERA 506 KM 1 TORRE SAN CRISTOBAL STE 209
COTO LAUREL PR
00780
US

V. Phone/Fax

Practice location:
  • Phone: 98-878-7259
  • Fax:
Mailing address:
  • Phone: 98-878-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIYADY VELAZQUEZ PAGAN
Title or Position: PRESIDENTA
Credential: PHD
Phone: 787-632-9786