Provider Demographics
NPI:1396795985
Name:VARELA, GILBERT R (MD)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:R
Last Name:VARELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5233 E BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:323-724-6911
Mailing Address - Fax:323-724-6915
Practice Address - Street 1:5232 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2002
Practice Address - Country:US
Practice Address - Phone:323-724-6911
Practice Address - Fax:323-724-6915
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10976197OtherCAQH
CA970029OtherQUALIFIED MED EVALUATOR
CAF38992Medicare UPIN
CA10976197OtherCAQH