1962421446 NPI number — MISS GRISELLE M VELAZQUEZ MD

Table of content: MISS GRISELLE M VELAZQUEZ MD (NPI 1962421446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962421446 NPI number — MISS GRISELLE M VELAZQUEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VELAZQUEZ
Provider First Name:
GRISELLE
Provider Middle Name:
M
Provider Name Prefix Text:
MISS
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:
1962421446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 CALLE MUNOZ RIVERA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENUELAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00624-2015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-836-1683
Provider Business Mailing Address Fax Number:
787-836-1683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
APTADO 515
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-869-5900
Provider Business Practice Location Address Fax Number:
787-869-6120
Provider Enumeration Date:
07/18/2006

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: 208D00000X , with the licence number:  14672 , 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)

  • Identifier: 200199 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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