Provider Demographics
NPI:1891122263
Name:DR. AXEL W. VELEZ SANTIAGO CSP
Entity Type:Organization
Organization Name:DR. AXEL W. VELEZ SANTIAGO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AXEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-892-2217
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:787-892-2217
Mailing Address - Fax:
Practice Address - Street 1:58 CALLE DR SANTIAGO VEVE STE 1
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4050
Practice Address - Country:US
Practice Address - Phone:787-892-2217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10648207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83645Medicare PIN
F73473Medicare UPIN