Provider Demographics
NPI:1013109370
Name:VELA, GUSTAVO ALONZO JR (DMSC, MA, MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ALONZO
Last Name:VELA
Suffix:JR
Gender:M
Credentials:DMSC, MA, MPAS, 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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2250
Mailing Address - Fax:956-362-2251
Practice Address - Street 1:2717 MICHAELANGELO DR STE 200
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1412
Practice Address - Country:US
Practice Address - Phone:956-362-2250
Practice Address - Fax:956-362-2251
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant