Provider Demographics
NPI:1104619063
Name:VARELA, KHRYSTINA (PPS)
Entity type:Individual
Prefix:
First Name:KHRYSTINA
Middle Name:
Last Name:VARELA
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301142
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92030-1142
Mailing Address - Country:US
Mailing Address - Phone:619-314-2070
Mailing Address - Fax:
Practice Address - Street 1:122 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4134
Practice Address - Country:US
Practice Address - Phone:760-432-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2400260571041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool