Healthcare Provider Details

I. General information

NPI: 1437761822
Provider Name (Legal Business Name): KIMBERLY VELAZQUEZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 CALLE MUNOZ RIVERA S
SAN LORENZO PR
00754-4212
US

IV. Provider business mailing address

URB. VEREDAS, CAMINO DE LOS CEDROS #743
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax: 787-739-8190
Mailing address:
  • Phone: 787-241-9536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number23832
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23832
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: