Provider Demographics
NPI:1467639674
Name:VELA, HUMBERTO JR (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:
Last Name:VELA
Suffix:JR
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CALLE DEL NORTE STE 6
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5943
Mailing Address - Country:US
Mailing Address - Phone:956-319-2579
Mailing Address - Fax:956-717-2604
Practice Address - Street 1:1401 CALLE DEL NORTE STE 6
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5943
Practice Address - Country:US
Practice Address - Phone:956-319-2579
Practice Address - Fax:956-717-2604
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX010492251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7003736OtherSTATE ASSIGNED
TX001016466Medicaid
TX7003736OtherSTATE ASSIGNED