Healthcare Provider Details

I. General information

NPI: 1427017383
Provider Name (Legal Business Name): JANET IGDALIA VELEZ MALDONADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 AVE ROOSEVELT PUERTO NUEVO
SAN JUAN PR
00920-2904
US

IV. Provider business mailing address

MONTEHIEDRA MALL 159 PITIRRE ST
SAN JUAN PR
00926-7007
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-8316
  • Fax:
Mailing address:
  • Phone: 787-720-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13063
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: