Provider Demographics
NPI:1750322962
Name:VELEZ SOTO, HERIBERTO (MD)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:VELEZ SOTO
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:PEDRO A CAMPO AVE. #152
Mailing Address - Street 2:
Mailing Address - City:AQUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-891-2444
Mailing Address - Fax:787-891-2444
Practice Address - Street 1:PEDRO A CAMPO AVE #152 STREET 107
Practice Address - Street 2:
Practice Address - City:AQUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-2444
Practice Address - Fax:787-891-2444
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9773208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
9773OtherRR
S18907Medicare UPIN
9773OtherRR