Provider Demographics
NPI:1275664005
Name:VELEZ MEDIAVILLA, JOSE A
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:VELEZ MEDIAVILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARIELYS
Other - Middle Name:
Other - Last Name:AMBULANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5215
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5215
Mailing Address - Country:US
Mailing Address - Phone:787-280-2532
Mailing Address - Fax:
Practice Address - Street 1:CARR 119 KM 1.2
Practice Address - Street 2:BO CALABAZA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-5215
Practice Address - Country:US
Practice Address - Phone:787-280-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 4553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1275664005OtherMCS REFORMA
PR1275664005OtherMCS CLASSICARE
PR9962OtherAMERICAN HEALTH MEDICARE
PR50741OtherPMC
PR1275664005OtherMCS CLASSICARE