MEDICARE: JONATHAN MARTIN VELA MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	16403	AZ
2	225400000X	Rehabilitation Practitioner
3	106H00000X	Marriage & Family Therapist	146926	CA

General Provider Information

NPI Number	:	1710629647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MARTIN VELA MA, LMFT

Provider Business Mailing Address
First Line	:	1125 N FAIRFAX AVE UNIT 46081
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-8707
Country	:	US
Telephone Number	:	424-262-3979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 N FAIRFAX AVE UNIT 46081
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-8707
Country	:	US
Telephone Number	:	424-262-3979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	08/06/2025

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