Provider Demographics
NPI:1104646470
Name:VELES JEREZ, BRYAN ALEJANDRO
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ALEJANDRO
Last Name:VELES JEREZ
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 1:25222 NORTHWEST FWY APT 377
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1068
Mailing Address - Country:US
Mailing Address - Phone:346-652-9854
Mailing Address - Fax:
Practice Address - Street 1:25222 NORTHWEST FWY APT 377
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1068
Practice Address - Country:US
Practice Address - Phone:346-652-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist