Healthcare Provider Details

I. General information

NPI: 1063334332
Provider Name (Legal Business Name): DR RENAN L VELAZQUEZ ORTIZ MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 AVE GENERAL VALERO
FAJARDO PR
00738-3998
US

IV. Provider business mailing address

URB LA CUMBRE CALLE WASHINGTON 690
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-0505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RENAN VELAZQUEZ ORTIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-999-9999