Healthcare Provider Details

I. General information

NPI: 1184601833
Provider Name (Legal Business Name): YOLANDA MARIA VELEZ-MORALES PH. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 4 BOX 7196
JUANA DIAZ PR
00795-9602
US

IV. Provider business mailing address

54 VILLA CANONA PARC VIEJAS AGUILITA
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-837-6623
  • Fax: 787-617-5532
Mailing address:
  • Phone: 787-837-6623
  • Fax: 787-617-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4523
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: