Healthcare Provider Details

I. General information

NPI: 1417812488
Provider Name (Legal Business Name): LOVE LEE VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA COND. SAN VICENTE SUITE 412
PONCE PR
00717
US

IV. Provider business mailing address

8169 CALLE CONCORDIA COND. SAN VICENTE SUITE 412
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax:
Mailing address:
  • Phone: 787-284-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: