Provider Demographics
NPI:1790199032
Name:VELEZ, KYRA (PBT)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PBT
Other - Prefix:
Other - First Name:KYRA
Other - Middle Name:
Other - Last Name:LEDWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PBT
Mailing Address - Street 1:PO BOX 1282
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-1282
Mailing Address - Country:US
Mailing Address - Phone:808-315-0777
Mailing Address - Fax:808-339-7455
Practice Address - Street 1:53-474 HALAULA-MAULILI RD
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-315-0777
Practice Address - Fax:808-339-7455
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-14
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI46060246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy