Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 888 | PR |
NPI | 1033224043 |
---|---|
Provider Name | Dr. Hernan J. Velez-Juan |
First Address | Bayamon, PR 00959-7206 |
Second Address | Bayamon, PR 00959-7206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
888 | STATE LICENSE NUMBER (01) | PR |