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NPI Code Detail

MEDICARE: MR. JASON BARELA

MEDICARE: MR. JASON BARELA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerFL

General Provider Information

NPI Number : 1063139095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON BARELA
Provider Business Mailing Address
First Line : 5150 NW MILNER DR
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34983-3392
Country : US
Telephone Number : 772-873-4938
Fax Number :
Provider Business Practice Location Address
First Line : 5150 NW MILNER DR
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34983-3392
Country : US
Telephone Number : 772-873-4938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2022
Last Update Date : 10/20/2022

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Directions to “ MR. JASON BARELA ” Practice Location

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