Healthcare Provider Details

I. General information

NPI: 1669462651
Provider Name (Legal Business Name): WILFREDO VELAZQUEZ CAPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFIO RODVAL, CALLE SAN MARTIN CARR 2, KM 4.9, BUCHANAN
GUANABO PR
00968
US

IV. Provider business mailing address

PO BOX 34070
FORT BUCHANAN PR
00934-0070
US

V. Phone/Fax

Practice location:
  • Phone: 787-775-1200
  • Fax:
Mailing address:
  • Phone: 787-775-7200
  • Fax: 787-775-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4296
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: