Provider Demographics
NPI:1861461261
Name:VELILLA IGLESIAS, MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:VELILLA IGLESIAS
Suffix:
Gender:M
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:PO BOX 362318
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2318
Mailing Address - Country:US
Mailing Address - Phone:787-728-8338
Mailing Address - Fax:787-727-0507
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:SAN JORGE MEDICAL BUILDING, SUITE 405
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3239
Practice Address - Country:US
Practice Address - Phone:787-728-8338
Practice Address - Fax:787-727-0507
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC84228Medicare UPIN
PR0087849AMedicare ID - Type UnspecifiedPROVIDER