Provider Demographics
NPI:1982892162
Name:VELEZ COLON, WAIKA DENISSE (MD)
Entity type:Individual
Prefix:DR
First Name:WAIKA
Middle Name:DENISSE
Last Name:VELEZ COLON
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:CALLE FELIPE II
Mailing Address - Street 2:MANSION REAL #604
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-908-7646
Mailing Address - Fax:
Practice Address - Street 1:AVE. TITO CASTRO 909
Practice Address - Street 2:TORRE MEDICA SAN LUCAS SUITE 602
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-651-1429
Practice Address - Fax:787-651-1430
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14507208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14507OtherMEDICAL LICENSE
PR1982892162Medicare UPIN
PR14507OtherMEDICAL LICENSE