Provider Demographics
NPI:1124175658
Name:PEREZ VELEZ, VICTORIA (MED TECHNOLOGY)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PEREZ VELEZ
Suffix:
Gender:F
Credentials:MED TECHNOLOGY
Other - Prefix:
Other - First Name:LAB
Other - Middle Name:CLINICO
Other - Last Name:ISABELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:222 RUTA 475
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-830-0050
Mailing Address - Fax:787-830-0050
Practice Address - Street 1:CARR 474 KM 29 GALATEO BAJO
Practice Address - Street 2:
Practice Address - City:ISABLEA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-0050
Practice Address - Fax:787-835-0050
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1006246RM2200X
PR246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30202OtherTRIPLE S
PR30202OtherTRIPLE S