Provider Demographics
NPI:1508830696
Name:VARELA, ANGELIQUE FERRER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:FERRER
Last Name:VARELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 N PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1610
Mailing Address - Country:US
Mailing Address - Phone:928-607-0323
Mailing Address - Fax:
Practice Address - Street 1:3801 N PARADISE RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1610
Practice Address - Country:US
Practice Address - Phone:928-607-0323
Practice Address - Fax:928-526-5763
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ168783004Medicaid
CAF87567Medicare ID - Type UnspecifiedMEDICARE