Healthcare Provider Details

I. General information

NPI: 1518467802
Provider Name (Legal Business Name): JESUS ERNESTO VARELA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4872
US

IV. Provider business mailing address

53620 AVENIDA CORTEZ
LA QUINTA CA
92253-3253
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-6511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: