Basic Information
| Provider Information | |||||||||
| NPI: | 1336447689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARELA | ||||||||
| FirstName: | XAVIER | ||||||||
| MiddleName: | FERNANDO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4234 RIVERWALK PKWY STE 230 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925053312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517813672 | ||||||||
| FaxNumber: | 9517810365 | ||||||||
| Practice Location | |||||||||
| Address1: | 4234 RIVERWALK PKWY STE 230 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925053312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517813672 | ||||||||
| FaxNumber: | 9517810365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9105786 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.