Provider Demographics
NPI:1043314156
Name:VELEZ, LINDA ENID (DMD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ENID
Last Name:VELEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10600
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2431 BLVD LUIS A FERRE
Practice Address - Street 2:EDIF. PORRATA PILA # 307
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-841-6681
Practice Address - Fax:787-841-5307
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0463511223P0221X
PR22761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01637498Medicaid