Healthcare Provider Details

I. General information

NPI: 1205986023
Provider Name (Legal Business Name): NORMA FAJARDO-VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PIES- CPRS RECINTO DE CIENCIAS MEDICAS
SAN JUAN PR
00936
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-764-1760
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-764-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1302
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: