Healthcare Provider Details

I. General information

NPI: 1174012272
Provider Name (Legal Business Name): AMANDA VELA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E RUNDBERG LN STE B1
AUSTIN TX
78753-4860
US

IV. Provider business mailing address

825 E RUNDBERG LN STE B1
AUSTIN TX
78753-4860
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9600
  • Fax:
Mailing address:
  • Phone: 956-874-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT2523
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: