Individual
CRISELLE DOMINI CODOG VELASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2434 HICKORY ST, ABILENE, TX 79698-0001
(325) 670-1702
Mailing address
7024 ROBBIE RD, ODESSA, TX 79765-8931
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA19872
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/06/2025
Last updated
02/12/2026
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