Provider Demographics
NPI:1962155176
Name:VELEZ LUGO, GABRIEL A (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:A
Last Name:VELEZ LUGO
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 1:150 CALLE JOBOS
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-2131
Mailing Address - Country:US
Mailing Address - Phone:939-402-0011
Mailing Address - Fax:
Practice Address - Street 1:150 CALLE JOBOS
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-2131
Practice Address - Country:US
Practice Address - Phone:939-402-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22602208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice