Healthcare Provider Details

I. General information

NPI: 1780077511
Provider Name (Legal Business Name): VIVIANA VELEZ ROSARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE ANTONIO ALCAZAR
FLORIDA PR
00650-1912
US

IV. Provider business mailing address

PO BOX 821
BARCELONETA PR
00617-0821
US

V. Phone/Fax

Practice location:
  • Phone: 787-822-2170
  • Fax:
Mailing address:
  • Phone: 787-679-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12913
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: