Healthcare Provider Details

I. General information

NPI: 1306982731
Provider Name (Legal Business Name): MR. EDGARDO VELAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CALLE SOLDADO ALCIDES REYES SAN AGUSTIN
SAN JUAN PR
00923-3214
US

IV. Provider business mailing address

411 CALLE SOLDADO ALCIDES REYES SAN AGUSTIN
SAN JUAN PR
00923-3214
US

V. Phone/Fax

Practice location:
  • Phone: 787-533-3818
  • Fax:
Mailing address:
  • Phone: 787-533-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberTC AMB 415
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: