Provider Demographics
NPI:1962421446
Name:VELAZQUEZ, GRISELLE M (MD)
Entity type:Individual
Prefix:MISS
First Name:GRISELLE
Middle Name:M
Last Name:VELAZQUEZ
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 1:418 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-2015
Mailing Address - Country:US
Mailing Address - Phone:787-836-1683
Mailing Address - Fax:787-836-1683
Practice Address - Street 1:APTADO 515
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-5900
Practice Address - Fax:787-869-6120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14672208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR200199OtherMMM
PRH96235Medicare UPIN
PRGHG5AMedicare PIN