Provider Demographics
NPI:1528020419
Name:CARDONA - VELEZ, VICTOR JOSE (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOSE
Last Name:CARDONA - VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CALLE MALAGUETA
Mailing Address - Street 2:URB. CIUDAD JARDIN
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9660
Mailing Address - Country:US
Mailing Address - Phone:787-400-3435
Mailing Address - Fax:
Practice Address - Street 1:GALENOS CENTRO DE MEDICINA INTERNA
Practice Address - Street 2:SAN LORENZO MALL LOCAL 42
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-400-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12362207L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81511OtherSSS