MEDICARE: IRIAMAR VELEZ QUINONES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	14985	PR

General Provider Information

NPI Number	:	1336143379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIAMAR VELEZ QUINONES MD

Provider Business Mailing Address
First Line	:	PO BOX 141721
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-1721
Country	:	US
Telephone Number	:	787-878-3211
Fax Number	:	787-878-3211

Provider Business Practice Location Address
First Line	:	AVE MIRAMAR NO 517
Second Line	:	SUITE 2
City	:	ARECIBO
State	:	PR
Zip	:	00612-4371
Country	:	US
Telephone Number	:	787-878-3211
Fax Number	:	787-878-3211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/24/2008

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