Basic Information
| Provider Information | |||||||||
| NPI: | 1790447035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ VELEZ | ||||||||
| FirstName: | SEBASTIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CALLE CABAN | ||||||||
| Address2: | |||||||||
| City: | CAMUY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006272318 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | EDIFICIO COMERCIAL LOCAL 1 | ||||||||
| Address2: | URB. CATALANA #66 | ||||||||
| City: | BARCELONETA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006170061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879153000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2021 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1341 | PR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6747517 | 01 | PR | DRIVERS LICENSE | OTHER |