Healthcare Provider Details

I. General information

NPI: 1306701537
Provider Name (Legal Business Name): MR. OMAR ROBERTO VARELA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N EUCLID AVE
UPLAND CA
91786-6031
US

IV. Provider business mailing address

915 SPERRY DR
COLTON CA
92324-2648
US

V. Phone/Fax

Practice location:
  • Phone: 619-353-7050
  • Fax:
Mailing address:
  • Phone: 619-353-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: