Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14857 | PR |
NPI | 1033311766 |
---|---|
Provider Name | Guillermina Antonia Velazquez |
First Address | Carolina, PR 00985 |
Second Address | Carolina, PR 00985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |