Provider Demographics
NPI:1750344693
Name:WILMA A . OLIVIERI VELEZ
Entity type:Organization
Organization Name:WILMA A . OLIVIERI VELEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVIERI VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-892-4651
Mailing Address - Street 1:85 AVE UNIV INTERAMERICANA
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4343
Mailing Address - Country:US
Mailing Address - Phone:787-892-4651
Mailing Address - Fax:787-892-4651
Practice Address - Street 1:85 AVE UNIV INTERAMERICANA
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4343
Practice Address - Country:US
Practice Address - Phone:787-892-4651
Practice Address - Fax:787-892-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR676291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038356Medicare PIN