Healthcare Provider Details

I. General information

NPI: 1457636904
Provider Name (Legal Business Name): LILLIAN M VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 AVE UNIVERSIDAD INTERARMERICANA ABAJO
SAN GERMAN PR
00683-3983
US

IV. Provider business mailing address

85 AVE UNIVERSIDAD INTERARMERICANA ABAJO
SAN GERMAN PR
00683-3983
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-4651
  • Fax: 787-892-4651
Mailing address:
  • Phone: 787-892-4651
  • Fax: 787-892-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number1111
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number676
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: