Provider Demographics
NPI:1235380684
Name:VELEZ LOPEZ, ENIDIA
Entity Type:Individual
Prefix:
First Name:ENIDIA
Middle Name:
Last Name:VELEZ LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LABORATORIO
Other - Middle Name:
Other - Last Name:CLINICO YOED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0628
Mailing Address - Country:US
Mailing Address - Phone:787-873-4260
Mailing Address - Fax:
Practice Address - Street 1:39 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1812
Practice Address - Country:US
Practice Address - Phone:787-873-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR553291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038333Medicare PIN