Provider Demographics
NPI:1205034717
Name:VARELA-ORTIZ, MARIA R (LND)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:R
Last Name:VARELA-ORTIZ
Suffix:
Gender:F
Credentials:LND
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Mailing Address - Street 1:401 AVE AMERICO MIRANDA
Mailing Address - Street 2:COOP LOS ROBLES APT 706-B
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4632
Mailing Address - Country:US
Mailing Address - Phone:787-758-6972
Mailing Address - Fax:787-758-6972
Practice Address - Street 1:196 CALLE JUAN P DUARTE
Practice Address - Street 2:PRIMER PISO COND DUARTE
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-3611
Practice Address - Country:US
Practice Address - Phone:787-759-6909
Practice Address - Fax:787-758-6972
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR869133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6500090OtherHUMANA
PR6500090OtherHUMANA