Healthcare Provider Details

I. General information

NPI: 1366728909
Provider Name (Legal Business Name): CHRISTOPHER RYAN VELA PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRIARWOOD AVE
MIDLAND TX
79707-2753
US

IV. Provider business mailing address

400 ROSALIND REDFERN GROVER PKWY STE 240
MIDLAND TX
79701-5856
US

V. Phone/Fax

Practice location:
  • Phone: 432-682-5385
  • Fax: 432-682-1265
Mailing address:
  • Phone: 432-683-2723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07511
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: