Healthcare Provider Details

I. General information

NPI: 1659198489
Provider Name (Legal Business Name): MICHAEL ANGEL VELA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COFFEE RD
MODESTO CA
95355-1305
US

IV. Provider business mailing address

3500 COFFEE RD
MODESTO CA
95355-1305
US

V. Phone/Fax

Practice location:
  • Phone: 209-341-0814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH199995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: