Provider Demographics
NPI:1851975064
Name:VELEZ RODRIGUEZ, ILIA VIVIANA
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:VIVIANA
Last Name:VELEZ RODRIGUEZ
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:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0044
Mailing Address - Country:US
Mailing Address - Phone:939-969-3062
Mailing Address - Fax:
Practice Address - Street 1:4 CALLE CARROUSEL
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4218
Practice Address - Country:US
Practice Address - Phone:939-969-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15694-I207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine