1861461261 NPI number — DR. MANUEL VELILLA IGLESIAS M.D.

Table of content: DR. MANUEL VELILLA IGLESIAS M.D. (NPI 1861461261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861461261 NPI number — DR. MANUEL VELILLA IGLESIAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VELILLA IGLESIAS
Provider First Name:
MANUEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1861461261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 362318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-728-8338
Provider Business Mailing Address Fax Number:
787-727-0507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
252 CALLE SAN JORGE
Provider Second Line Business Practice Location Address:
SAN JORGE MEDICAL BUILDING, SUITE 405
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00912-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-8338
Provider Business Practice Location Address Fax Number:
787-727-0507
Provider Enumeration Date:
03/16/2006

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: 207V00000X , with the licence number:  5373 , 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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