Healthcare Provider Details

I. General information

NPI: 1265514558
Provider Name (Legal Business Name): IVAN H. VELAZQUEZ MUNOZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE JESUS T PINERO SUITE 3
ISABELA PR
00662-0674
US

IV. Provider business mailing address

PO BOX 674
ISABELA PR
00662-0674
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-5860
  • Fax: 787-872-5860
Mailing address:
  • Phone: 787-872-5860
  • Fax: 787-872-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number9959
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: