Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 474 | PR |
NPI | 1093001927 |
---|---|
Provider Name | Rafael Antonio Velez |
First Address | Isabela, PR 00662 |
Second Address | Isabela, PR 00662-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 20/06/2011 |