MEDICARE: WILMA A . OLIVIERI 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	291U00000X	Clinical Medical Laboratory	676	PR

General Provider Information

NPI Number	:	1750344693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILMA A . OLIVIERI VELEZ

Provider Business Mailing Address
First Line	:	85 AVE UNIV INTERAMERICANA
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4343
Country	:	US
Telephone Number	:	787-892-4651
Fax Number	:	787-892-4651

Provider Business Practice Location Address
First Line	:	85 AVE UNIV INTERAMERICANA
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4343
Country	:	US
Telephone Number	:	787-892-4651
Fax Number	:	787-892-4651

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. WILMA A OLIVIERI VELEZ
Credential	:	M.T.
Telephone Number	:	787-892-4651

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	12/05/2016

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