Provider Demographics
NPI:1578345732
Name:VARELA DELIZ MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:VARELA DELIZ MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDIEL
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:VARELA DELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-602-0322
Mailing Address - Street 1:48 AVE MUNOZ RIVERA
Mailing Address - Street 2:COND AQUABLUE APT 2106
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-602-0322
Mailing Address - Fax:
Practice Address - Street 1:1801 SANTURCE MEDICAL MALL
Practice Address - Street 2:AVE PONCE DE LEON OFICINA 403
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-728-1193
Practice Address - Fax:787-726-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty