Basic Information
Provider Information
NPI: 1295208411
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VELEZ QUINONES
FirstName: MIGUEL
MiddleName: PRIMO
NamePrefix:  
NameSuffix:  
Credential:  
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Mailing Information
Address1: 30 CALLE 9
Address2: ALTURAS DE TORRIMAR
City: GUAYNABO
State: PR
PostalCode: 00969
CountryCode: US
TelephoneNumber: 7876717568
FaxNumber:  
Practice Location
Address1: BO MONACILLO #150 AVE AMERICO MIRANDA
Address2:  
City: SAN JUAN
State: PR
PostalCode: 00935
CountryCode: US
TelephoneNumber: 7877634149
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/10/2019
LastUpdateDate: 08/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X16159-IPRY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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