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General NPI Number Information
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NPI Number | 1578345732
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Entity Type | Organization
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Legal Business Name | VARELA DELIZ MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 1801 SANTURCE MEDICAL MALL AVE PONCE DE LEON OFICINA 403
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City | SAN JUAN
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State | PR
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Zip | 00909
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Country | US
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Telephone | 787-728-1193
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Fax | 787-726-4244
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Provider Business Mailing Address
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Address Line | 48 AVE MUNOZ RIVERA COND AQUABLUE APT 2106
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-602-0322
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDIEL JAVIER VARELA DELIZ
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Credential |
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Telephone | 787-602-0322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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