Provider Demographics
NPI:1477289478
Name:VELEZ, BRYAN ALEXIS (PA 01042)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ALEXIS
Last Name:VELEZ
Suffix:
Gender:M
Credentials:PA 01042
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:ALEXIS
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:URB EL SENORIAL CALLE BENITO FEIJOO
Mailing Address - Street 2:2038
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-529-3131
Mailing Address - Fax:
Practice Address - Street 1:CUPEY GARDENS PLAZA AVE CUPEY GARDENS #200 SUITE 11-W
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-760-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR01042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant