Provider Demographics
NPI:1154370963
Name:VELADO, IVONNE (PA-C)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:VELADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 BAY RD STE A
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-5312
Mailing Address - Country:US
Mailing Address - Phone:650-321-0980
Mailing Address - Fax:650-321-0988
Practice Address - Street 1:1798 BAY RD STE A
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-5312
Practice Address - Country:US
Practice Address - Phone:650-321-0980
Practice Address - Fax:650-321-0988
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16275363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP62902Medicare UPIN