MEDICARE: MARIA JULIETA VICHARELLI

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
1	363LF0000X	Family Nurse Practitioner	716010	TX

General Provider Information

NPI Number	:	1871077735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA JULIETA VICHARELLI

Provider Business Mailing Address
First Line	:	3822 CRESTWIND
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-8190
Country	:	US
Telephone Number	:	956-795-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 UNIVERSITY BLVD
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-1920
Country	:	US
Telephone Number	:	956-326-3280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/16/2020

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