Healthcare Provider Details

I. General information

NPI: 1679485056
Provider Name (Legal Business Name): ANGELIS M SAMALOT VELEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 ZONA INDUSTRIAL REPARADA 2 PONCE PR 00716-2347
PONCE PR
00716-2347
US

IV. Provider business mailing address

PO BOX 2347
ISABELA PR
00662-9347
US

V. Phone/Fax

Practice location:
  • Phone: 787-462-8012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: