Healthcare Provider Details

I. General information

NPI: 1275757288
Provider Name (Legal Business Name): EDISON VELEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DE INFANTERIA #23 NORTH
LAJAS PR
00667
US

IV. Provider business mailing address

PO BOX 465
LAJAS PR
00667-0465
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-5209
  • Fax: 787-899-5209
Mailing address:
  • Phone: 787-899-5209
  • Fax: 787-899-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number10834
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: