Healthcare Provider Details

I. General information

NPI: 1457903221
Provider Name (Legal Business Name): ALEXANDRA VELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMINO LA COSTA
AUSTIN TX
78752
US

IV. Provider business mailing address

1101 CAMINO LA COSTA
AUSTIN TX
78752-3930
US

V. Phone/Fax

Practice location:
  • Phone: 512-478-4939
  • Fax:
Mailing address:
  • Phone: 512-478-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22266
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: