1184743254 NPI number — DR. MAYRA VELEZ RIVERA MD

Table of content: DR. MAYRA VELEZ RIVERA MD (NPI 1184743254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184743254 NPI number — DR. MAYRA VELEZ RIVERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VELEZ RIVERA
Provider First Name:
MAYRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184743254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 URB VILLA BLANCA
Provider Second Line Business Mailing Address:
PMB 611
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-748-3818
Provider Business Mailing Address Fax Number:
787-748-3818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSPITAL MENONITA CAYEY CARR 14 KM 72.0 BO RINCON
Provider Second Line Business Practice Location Address:
SEC LOMAS
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00737-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-535-1001
Provider Business Practice Location Address Fax Number:
787-535-1012
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  12905 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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