Basic Information
| Provider Information | |||||||||
| NPI: | 1962040360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELIZ | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2267 TRAWOOD DR STE G2 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799353027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152569751 | ||||||||
| FaxNumber: | 9159742344 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 W HAGUE RD STE 180 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799025811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153171660 | ||||||||
| FaxNumber: | 9159742344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2019 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP144218 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP144218 | 01 | TX | TEXAS NURSING BOARD APRN | OTHER | 832369 | 01 | TX | TEXAS NURSING BOARD RN | OTHER |