Healthcare Provider Details

I. General information

NPI: 1376871855
Provider Name (Legal Business Name): NATHAN DANIEL VELA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST MAILSTOP 112
MIAMI FL
33125
US

IV. Provider business mailing address

1201 NW 16TH ST MAILSTOP #112
MIAMI FL
33125
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax: 305-575-7234
Mailing address:
  • Phone: 305-904-5900
  • Fax: 954-990-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3460
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: