Healthcare Provider Details

I. General information

NPI: 1336306505
Provider Name (Legal Business Name): FERNANDO VELEZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9533 SOUTHWEST FWY
HOUSTON TX
77074-1409
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 713-774-7774
  • Fax: 713-774-7775
Mailing address:
  • Phone: 210-928-2814
  • Fax: 210-928-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24296
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: