Provider Demographics
NPI:1992453401
Name:FONSECA VELEZ, HECTOR J (MEDICAL STUDENT)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:J
Last Name:FONSECA VELEZ
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAIROA GOLDEN GATE 2 CALLE N I-1
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-597-7653
Mailing Address - Fax:
Practice Address - Street 1:BAIROA GOLDEN GATE 2 CALLE N I-1
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-597-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program