Healthcare Provider Details

I. General information

NPI: 1285619536
Provider Name (Legal Business Name): ELBA VELAZQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 CALLE MUNOZ RIVERA MUNOZ RIVERA 959
PENUELAS PR
00624-2022
US

IV. Provider business mailing address

PO BOX 68
PENUELAS PR
00624-0068
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-7603
  • Fax:
Mailing address:
  • Phone: 787-836-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10420
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: