Provider Demographics
NPI:1124219639
Name:VELA, CARLOS IAN (PA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:IAN
Last Name:VELA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 HYLTON AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2715
Mailing Address - Country:US
Mailing Address - Phone:956-648-3681
Mailing Address - Fax:
Practice Address - Street 1:2703 HYLTON AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2715
Practice Address - Country:US
Practice Address - Phone:956-648-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant