Healthcare Provider Details

I. General information

NPI: 1417512849
Provider Name (Legal Business Name): EDGARDO OMAR VELEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/22/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 AVE VALERO
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 10627
SAN JUAN PR
00922-0627
US

V. Phone/Fax

Practice location:
  • Phone: 787-655-0505
  • Fax:
Mailing address:
  • Phone: 787-951-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number023821
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: