Healthcare Provider Details

I. General information

NPI: 1235051673
Provider Name (Legal Business Name): JESENIA VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 AVE. HOSTOS SUITE A3 MEDICAL EMPORIUM II
MAYAGUEZ PR
00680-1509
US

IV. Provider business mailing address

BO PALOMAS CALLE A 2
YAUCO PR
00698
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-2785
  • Fax:
Mailing address:
  • Phone: 939-402-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003005
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: