Provider Demographics
NPI:1952599672
Name:JOSE A VELEZ MEDIAVILLA
Entity type:Organization
Organization Name:JOSE A VELEZ MEDIAVILLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELEZ MEDIAVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-280-2532
Mailing Address - Street 1:PO BOX 5215
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-280-2532
Mailing Address - Fax:
Practice Address - Street 1:CARR 119 INT 449 KM 1.2
Practice Address - Street 2:BO CALABAZA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-2532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB-4553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058735Medicare PIN