Provider Demographics
NPI:1619955218
Name:VELASQUEZ, NELLY DELCARMEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:DELCARMEN
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E 30TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3378
Mailing Address - Country:US
Mailing Address - Phone:512-236-1100
Mailing Address - Fax:512-236-1128
Practice Address - Street 1:900 E 30TH ST STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-236-1100
Practice Address - Fax:512-236-1128
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8M2500OtherBCBS
TX165096201Medicaid
8M2500OtherBCBS