Healthcare Provider Details

I. General information

NPI: 1982717286
Provider Name (Legal Business Name): IVAN F. VELEZ MIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE FD ROOSEVELT STE 401 LA TORRE DE PLAZA LAS AMERICAS
SAN JUAN PR
00918-8001
US

IV. Provider business mailing address

525 AVE FD ROOSEVELT STE 401 LA TORRE DE PLAZA LAS AMERICAS
SAN JUAN PR
00918-8001
US

V. Phone/Fax

Practice location:
  • Phone: 787-237-0554
  • Fax: 787-282-0472
Mailing address:
  • Phone: 787-237-0554
  • Fax: 787-282-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16235
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number16235
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: