Provider Demographics
NPI:1851500672
Name:ALEJANDRO, IVELISSE (OD)
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:ALEJANDRO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CALLE LA CIMA
Mailing Address - Street 2:GRAN VISTA 1
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5006
Mailing Address - Country:US
Mailing Address - Phone:787-535-1032
Mailing Address - Fax:787-738-5161
Practice Address - Street 1:CARR 14 BO MONTELLANO
Practice Address - Street 2:HOSPITAL MENONITA 205
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-535-1032
Practice Address - Fax:787-738-5161
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR538OtherLICENCE