Healthcare Provider Details

I. General information

NPI: 1295869436
Provider Name (Legal Business Name): ROBERTO VELAZQUEZ TORRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS
PONCE PR
00717-2113
US

IV. Provider business mailing address

2431 AVE LAS AMERICAS
PONCE PR
00717-2113
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-0587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number7161
License Number StatePR

VIII. Authorized Official

Name: DR. ROBERTO VELAZQUEZ
Title or Position: M.D.
Credential:
Phone: 787-841-0587