Provider Demographics
NPI:1598465015
Name:VARIAS, JUSTIN EDWARD MIRANDA (BS)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN EDWARD
Middle Name:MIRANDA
Last Name:VARIAS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:JUSTIN
Other - Middle Name:
Other - Last Name:VARIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:503 MASSON CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-8919
Mailing Address - Country:US
Mailing Address - Phone:832-948-3438
Mailing Address - Fax:
Practice Address - Street 1:925 CITY CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2981
Practice Address - Country:US
Practice Address - Phone:936-202-5202
Practice Address - Fax:936-202-5230
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program