1487853354 NPI number — DR. ANTONIO JOAQUIN VARELA DPT MHSC MTC

Table of content: (NPI 1962012088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487853354 NPI number — DR. ANTONIO JOAQUIN VARELA DPT MHSC MTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARELA
Provider First Name:
ANTONIO
Provider Middle Name:
JOAQUIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT MHSC MTC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487853354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 MOSES CREEK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-616-1282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5210 CORPORATE CENTER CT SE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LACEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98503-5952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-455-8155
Provider Business Practice Location Address Fax Number:
360-455-1655
Provider Enumeration Date:
07/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT60017380 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: 18058 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 236094 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2767VA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8525339 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3456VA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8873416 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8947463 . This is a "L&I CRIME" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2769VA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2766VA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6788VA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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