Provider Demographics
NPI:1386730786
Name:MEDINA-VELEZ, GISELLE (MD)
Entity type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:
Last Name:MEDINA-VELEZ
Suffix:
Gender:F
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:ESTANCIAS DEL GULF CLUB
Mailing Address - Street 2:510 LUIS MORALES
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0531
Mailing Address - Country:US
Mailing Address - Phone:787-608-2282
Mailing Address - Fax:
Practice Address - Street 1:2132 URB. VILLA GRILLASCA
Practice Address - Street 2:AVE LAS AMERICAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-608-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100945OtherLA CRUZ AZUL DE PR
PR3016OtherAPS HEALTH
PR57267 MEOtherTRIPLE S INC.
PR563472OtherFHC SYSTEMS
PR3016OtherAPS HEALTH
PRQ-49668Medicare UPIN