Provider Demographics
NPI:1558107391
Name:VELEZ, ENID ALICIA
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:ALICIA
Last Name:VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. NOGAL # 2157
Mailing Address - Street 2:LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:939-579-4099
Mailing Address - Fax:
Practice Address - Street 1:ST. NOGAL # 2157
Practice Address - Street 2:LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:939-579-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23817208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice