Healthcare Provider Details

I. General information

NPI: 1225163728
Provider Name (Legal Business Name): LUIS A VELEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LOS VETERANOS NUM 77
ENSENADA PR
00647
US

IV. Provider business mailing address

AVE. LOS VETERANOS NUM. 77 (LAJAS ROAD)
ENSENADA PR
00647
US

V. Phone/Fax

Practice location:
  • Phone: 787-829-0022
  • Fax: 787-829-3451
Mailing address:
  • Phone: 787-829-0022
  • Fax: 787-829-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number208D00000X GP
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: