Healthcare Provider Details

I. General information

NPI: 1518873322
Provider Name (Legal Business Name): DAVID ISMAEL VELA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14775 W YORKSHIRE DR
SURPRISE AZ
85374-7224
US

IV. Provider business mailing address

11602 N OLIVE ST
EL MIRAGE AZ
85335-5071
US

V. Phone/Fax

Practice location:
  • Phone: 623-594-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253551
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: