Healthcare Provider Details

I. General information

NPI: 1679921191
Provider Name (Legal Business Name): JUSTIN VELA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S COMMERCE ST
HARLINGEN TX
78550-7706
US

IV. Provider business mailing address

PO BOX 532620
HARLINGEN TX
78553-2620
US

V. Phone/Fax

Practice location:
  • Phone: 956-230-1851
  • Fax: 956-365-3557
Mailing address:
  • Phone: 956-230-1851
  • Fax: 956-365-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: