Provider Demographics
NPI:1619178407
Name:VELEZ, LEILA MILAGROS
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:MILAGROS
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:C-9 BROMELIA
Mailing Address - Street 2:PARQUE DE BUCARE I
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-396-6306
Mailing Address - Fax:
Practice Address - Street 1:C 9 BROMELIA STREET
Practice Address - Street 2:PARQUE DE BUCARE I
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-731-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27771835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2777OtherPHARMACIST LICENSE