Healthcare Provider Details

I. General information

NPI: 1679456297
Provider Name (Legal Business Name): MARIA DE LOS ANGELES VARELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 LEE BLVD STE 248
LEHIGH ACRES FL
33971-1322
US

IV. Provider business mailing address

12401 W OKEECHOBEE RD LOT 26
HIALEAH GARDENS FL
33018-2928
US

V. Phone/Fax

Practice location:
  • Phone: 239-201-9338
  • Fax: 888-368-6931
Mailing address:
  • Phone: 786-879-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-439619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: