Provider Demographics
NPI:1760048599
Name:VARELA DE SANCHEZ, MARIA GABRIELA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
Last Name:VARELA DE SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15460 SW 284TH ST UNIT 205
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1407
Mailing Address - Country:US
Mailing Address - Phone:786-797-3947
Mailing Address - Fax:
Practice Address - Street 1:15460 SW 284TH ST UNIT 205
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1407
Practice Address - Country:US
Practice Address - Phone:786-797-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-73776106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV643547877980Medicaid