Basic Information
| Provider Information | |||||||||
| NPI: | 1972574192 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VELEZ CORPORATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | NCA CORPORATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1699 WASHINGTON RD | ||||||||
| Address2: | STE 307 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152281629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128313744 | ||||||||
| FaxNumber: | 4128315663 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 S CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144435000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VELEZ | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8144435000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0018757160001 | 05 | PA | MEDICAID |