MEDICARE: GUSTAVO ROMERO VELEZ

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	35.145021	OH

General Provider Information

NPI Number	:	1528514361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO ROMERO VELEZ

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-445-5576
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2401
Country	:	US
Telephone Number	:	216-445-5576
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	04/28/2022

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Directions to “ GUSTAVO ROMERO VELEZ ” Practice Location

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