Provider Demographics
NPI:1588209167
Name:GARCIA VELEZ, DWAYNE (MEDICAL STUDENT)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:GARCIA VELEZ
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE TOLEDO 128
Mailing Address - Street 2:ESTANCIAS DE TORTUGUERO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3602
Mailing Address - Country:US
Mailing Address - Phone:787-502-2899
Mailing Address - Fax:
Practice Address - Street 1:CALLE TOLEDO 128
Practice Address - Street 2:ESTANCIAS DE TORTUGUERO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-3602
Practice Address - Country:US
Practice Address - Phone:787-502-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23878207R00000X
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program