Healthcare Provider Details

I. General information

NPI: 1366304081
Provider Name (Legal Business Name): JAVIER JOSE VELEZ RULLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B17 URB CABRERA
UTUADO PR
00641-2469
US

IV. Provider business mailing address

B17 URB CABRERA
UTUADO PR
00641-2469
US

V. Phone/Fax

Practice location:
  • Phone: 787-615-9601
  • Fax:
Mailing address:
  • Phone: 787-615-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17278I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: