Healthcare Provider Details

I. General information

NPI: 1568610038
Provider Name (Legal Business Name): VANESSA L VELA MARTINEZ M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 OAK CENTRE DR STE 170
SAN ANTONIO TX
78258-3944
US

IV. Provider business mailing address

2218 SAWGRASS RDG
SAN ANTONIO TX
78260-7237
US

V. Phone/Fax

Practice location:
  • Phone: 210-495-4888
  • Fax: 210-495-1333
Mailing address:
  • Phone: 210-685-9900
  • Fax: 210-495-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberL5999
License Number StateTX

VIII. Authorized Official

Name: VANESSA L VELA MARTINEZ
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 210-495-4888