Provider Demographics
NPI:1720628175
Name:VARELA, ROSELLA SIMONITA
Entity Type:Individual
Prefix:
First Name:ROSELLA
Middle Name:SIMONITA
Last Name:VARELA
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:HWY 111 #1857
Mailing Address - Street 2:HC 67 #1857
Mailing Address - City:VALLECITOS
Mailing Address - State:NM
Mailing Address - Zip Code:87581
Mailing Address - Country:US
Mailing Address - Phone:575-582-0028
Mailing Address - Fax:
Practice Address - Street 1:HC 67 BOX 1857
Practice Address - Street 2:
Practice Address - City:VALLECITOS
Practice Address - State:NM
Practice Address - Zip Code:87581-9710
Practice Address - Country:US
Practice Address - Phone:575-582-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician