Provider Demographics
NPI:1558017517
Name:MALLET-VARELA, ORBEIN (APRN)
Entity Type:Individual
Prefix:
First Name:ORBEIN
Middle Name:
Last Name:MALLET-VARELA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 W 10TH CT # 25C
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4672
Mailing Address - Country:US
Mailing Address - Phone:210-471-9446
Mailing Address - Fax:
Practice Address - Street 1:7200 W 10TH CT # 25C
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4672
Practice Address - Country:US
Practice Address - Phone:210-471-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010553363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner