Provider Demographics
NPI:1740276047
Name:VELEZ SANTIAGO, AXEL W (MD)
Entity type:Individual
Prefix:DR
First Name:AXEL
Middle Name:W
Last Name:VELEZ SANTIAGO
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 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:787-892-5901
Practice Address - Street 1:58 CALLE SANTIAGO
Practice Address - Street 2:STE 1
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4440
Practice Address - Country:US
Practice Address - Phone:787-892-2217
Practice Address - Fax:787-892-2217
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10648207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F73473Medicare UPIN
PR83645Medicare ID - Type Unspecified