Provider Demographics
NPI:1508130683
Name:VELARDE, JESUS JAVIER SR
Entity Type:Individual
Prefix:MRS
First Name:JESUS
Middle Name:JAVIER
Last Name:VELARDE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CLINT SAN ELIZARIO RD
Mailing Address - Street 2:PO BOX 670
Mailing Address - City:SAN ELIZARIO
Mailing Address - State:TX
Mailing Address - Zip Code:79849-7501
Mailing Address - Country:US
Mailing Address - Phone:915-873-1679
Mailing Address - Fax:915-851-2614
Practice Address - Street 1:1045 CLINT SAN ELIZARIO RD
Practice Address - Street 2:
Practice Address - City:SAN ELIZARIO
Practice Address - State:TX
Practice Address - Zip Code:79849-7501
Practice Address - Country:US
Practice Address - Phone:915-873-1679
Practice Address - Fax:915-851-2614
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10753074171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications