Provider Demographics
NPI:1750498085
Name:VELEZ GONZALEZ, MARIO O (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:O
Last Name:VELEZ GONZALEZ
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:PO BOX 1410
Mailing Address - Street 2:65 DE INFANTERIA #57
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610
Mailing Address - Country:US
Mailing Address - Phone:787-826-3666
Mailing Address - Fax:787-826-3666
Practice Address - Street 1:AVE 65 DE INFANTERIA #57
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-3666
Practice Address - Fax:787-826-3666
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR100382083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82148OtherPTAN
F72609Medicare UPIN