Provider Demographics
NPI:1093799199
Name:VELEZ DE JESUS, ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:VELEZ DE JESUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 04 BOX 19741
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9801
Mailing Address - Country:US
Mailing Address - Phone:787-850-6654
Mailing Address - Fax:
Practice Address - Street 1:CARR #3 KM 85.6 CANDELERO ARRIBA
Practice Address - Street 2:EDIFICIO PLAZA DEL MAR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR500035SEOtherMEDICARE Y MUCHO MAS
PR0012654OtherHUMANA
PR3214OtherPREFERRED MEDICARE CHOICE
PR066037OtherCRUZ AZUL
PR27363OtherTRIPLE S
PR500035SEOtherMEDICARE Y MUCHO MAS
PR066037OtherCRUZ AZUL