Provider Demographics
NPI:1225163728
Name:VELEZ, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. LOS VETERANOS NUM. 77
Mailing Address - Street 2:(LAJAS ROAD)
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647
Mailing Address - Country:US
Mailing Address - Phone:787-829-0022
Mailing Address - Fax:787-829-3451
Practice Address - Street 1:AVE. LOS VETERANOS
Practice Address - Street 2:NUM 77
Practice Address - City:ENSENADA
Practice Address - State:PR
Practice Address - Zip Code:00647
Practice Address - Country:US
Practice Address - Phone:787-829-0022
Practice Address - Fax:787-829-3451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208D00000X GP173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89941OtherPIN
PRG89739Medicare UPIN