Provider Demographics
NPI:1457636904
Name:VELEZ, LILLIAN M
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:M
Last Name:VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 AVE UNIVERSIDAD INTERARMERICANA ABAJO
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-3983
Mailing Address - Country:US
Mailing Address - Phone:787-892-4651
Mailing Address - Fax:787-892-4651
Practice Address - Street 1:85 AVE UNIVERSIDAD INTERARMERICANA ABAJO
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-3983
Practice Address - Country:US
Practice Address - Phone:787-892-4651
Practice Address - Fax:787-892-4651
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1111246QM0706X
PR676291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038356Medicare UPIN