Provider Demographics
NPI:1003957853
Name:DR MIGUEL A. VELASCO MEDICINA INTERNA-CSP
Entity Type:Organization
Organization Name:DR MIGUEL A. VELASCO MEDICINA INTERNA-CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-831-8166
Mailing Address - Street 1:PO BOX 6517
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6517
Mailing Address - Country:US
Mailing Address - Phone:787-831-8166
Mailing Address - Fax:787-805-2122
Practice Address - Street 1:114 CALLE MCKINLEY W
Practice Address - Street 2:EDIF PLAZA YAGUEZ # 207
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3874
Practice Address - Country:US
Practice Address - Phone:787-831-8166
Practice Address - Fax:787-805-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF30645Medicare UPIN
PR0084847Medicare ID - Type UnspecifiedMEDICARE