Healthcare Provider Details

I. General information

NPI: 1629577747
Provider Name (Legal Business Name): PALOMA MARIA VELASCO CORRADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 CALLE 62 SE
SAN JUAN PR
00921-2724
US

IV. Provider business mailing address

576 AVE ARTERIAL B
SAN JUAN PR
00918-2200
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-638-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23221
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number23221
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: