Provider Demographics
NPI:1578648937
Name:VELASCO, LILIAN A (NP)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:A
Last Name:VELASCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 FANNIN STREET
Mailing Address - Street 2:ADVANCE PRACTICE OFFICE
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-704-2237
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN STREET
Practice Address - Street 2:ADVANCE PRACTICE OFFICE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693326363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28706Medicare UPIN
TX8J0836Medicare PIN