1275954067 NPI number — MISS VERONICA VARELA MARTINEZ RRW

Table of content: MISS VERONICA VARELA MARTINEZ RRW (NPI 1275954067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275954067 NPI number — MISS VERONICA VARELA MARTINEZ RRW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
VERONICA
Provider Middle Name:
VARELA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RRW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275954067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SPORTFISHER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92054-2550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-439-6702
Provider Business Mailing Address Fax Number:
760-439-4779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SPORTFISHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-439-6702
Provider Business Practice Location Address Fax Number:
760-439-4779
Provider Enumeration Date:
12/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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