Provider Demographics
NPI:1407053028
Name:VELEZ, ILEANA (BS PH)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:BS PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0996
Mailing Address - Country:US
Mailing Address - Phone:787-897-5913
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE RAMON DE JESUS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2204
Practice Address - Country:US
Practice Address - Phone:787-897-2464
Practice Address - Fax:787-897-3231
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2169354OtherDRIVER LICENCE