1578345732 NPI number — VARELA DELIZ MEDICAL GROUP, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578345732 NPI number — VARELA DELIZ MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VARELA DELIZ MEDICAL GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578345732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 AVE MUNOZ RIVERA
Provider Second Line Business Mailing Address:
COND AQUABLUE APT 2106
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-602-0322
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 SANTURCE MEDICAL MALL
Provider Second Line Business Practice Location Address:
AVE PONCE DE LEON OFICINA 403
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-1193
Provider Business Practice Location Address Fax Number:
787-726-4244
Provider Enumeration Date:
10/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
VARELA DELIZ
Authorized Official First Name:
EDIEL
Authorized Official Middle Name:
JAVIER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-602-0322

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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