MEDICARE: OSMAN VARELA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1891174140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSMAN VARELA

Provider Business Mailing Address
First Line	:	402 1/2 HARVARD DR
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 1/2 HARVARD DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-3527
Country	:	US
Telephone Number	:	505-219-6679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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Directions to “ OSMAN VARELA ” Practice Location

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