Healthcare Provider Details

I. General information

NPI: 1487465381
Provider Name (Legal Business Name): OSMARIE ANDREA VILLALOBOS VARELA SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 DUNVEGAN DR APT 102
CHARLOTTE NC
28278-6770
US

IV. Provider business mailing address

6111 DUNVEGAN DR APT 102
CHARLOTTE NC
28278-6770
US

V. Phone/Fax

Practice location:
  • Phone: 346-637-0507
  • Fax:
Mailing address:
  • Phone: 346-637-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22-342
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: