Provider Demographics
NPI:1386661205
Name:ANGELIQUE F. VARELA,M.D.
Entity Type:Organization
Organization Name:ANGELIQUE F. VARELA,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:F
Authorized Official - Last Name:VARELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-214-3667
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:202
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-214-3667
Mailing Address - Fax:928-773-2502
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:202
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1479
Practice Address - Country:US
Practice Address - Phone:928-214-3667
Practice Address - Fax:928-773-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87567Medicare UPIN