Provider Demographics
NPI:1265443667
Name:VELA, RODRIGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:VELA
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:CALLE 2 H-29 EXT.VILLA RICA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5029
Mailing Address - Country:US
Mailing Address - Phone:787-236-7623
Mailing Address - Fax:787-269-8181
Practice Address - Street 1:CALLE 2 H-29 EXT.VILLA RICA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5029
Practice Address - Country:US
Practice Address - Phone:787-236-7623
Practice Address - Fax:787-269-8181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16219174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23635Medicare ID - Type Unspecified
PRI-51977Medicare UPIN