Provider Demographics
NPI:1780302919
Name:VELA, CARLOS R
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:VELA
Suffix:
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 1:2121 E GRIFFIN PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3072
Mailing Address - Country:US
Mailing Address - Phone:956-583-2300
Mailing Address - Fax:956-622-5681
Practice Address - Street 1:2121 E GRIFFIN PKWY STE 6
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3072
Practice Address - Country:US
Practice Address - Phone:956-583-2300
Practice Address - Fax:956-622-5681
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PA19247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program