Provider Demographics
NPI:1417124843
Name:VELAZQUEZ, PAMELA SIFUENTES (PA- C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SIFUENTES
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6001
Mailing Address - Country:US
Mailing Address - Phone:956-686-6050
Mailing Address - Fax:
Practice Address - Street 1:3401 N. 23RD ST.
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-686-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant