MEDICARE: IVANISSE ORTIZ 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	207RP1001X	Pulmonary Disease Physician	22763	PR

General Provider Information

NPI Number	:	1669953196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVANISSE ORTIZ VELEZ

Provider Business Mailing Address
First Line	:	PO BOX 191267
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-1267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 191267
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-1267
Country	:	US
Telephone Number	:	787-480-2841
Fax Number	:

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

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	04/01/2026

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Directions to “ IVANISSE ORTIZ VELEZ ” Practice Location

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