Healthcare Provider Details

I. General information

NPI: 1013918168
Provider Name (Legal Business Name): RUBEN A. VELAZQUEZ ROUSSET, C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 AVE HOSTOS MEDICAL EMPORIUM SUITE 201
MAYAGUEZ PR
00680-1502
US

IV. Provider business mailing address

351 AVE HOSTOS MEDICAL EMPORIUM SUITE 201
MAYAGUEZ PR
00680-1502
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-4773
  • Fax: 787-986-6666
Mailing address:
  • Phone: 787-832-4773
  • Fax: 787-986-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number15369
License Number StatePR

VIII. Authorized Official

Name: DR. RUBEN ANTONIO VELAZQUEZ ROUSSET
Title or Position: OWNER
Credential: M.D., PH.D.
Phone: 787-832-4773