Provider Demographics
NPI:1346466836
Name:EMERGENCIOLOGOS PARA PUERTO RICO,CSP
Entity Type:Organization
Organization Name:EMERGENCIOLOGOS PARA PUERTO RICO,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-786-6493
Mailing Address - Street 1:PMB 338 35 JUAN CARLOS DE BORBON ST.
Mailing Address - Street 2:STE 67
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5375
Mailing Address - Country:US
Mailing Address - Phone:787-786-6493
Mailing Address - Fax:787-946-9377
Practice Address - Street 1:URB SANTA ROSA 20ST.
Practice Address - Street 2:30 BLQ 30
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-786-6493
Practice Address - Fax:787-946-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020027Medicare PIN