Provider Demographics
NPI:1437040417
Name:VARELA, JOSAFAT (CCSS, EMT-I)
Entity type:Individual
Prefix:MR
First Name:JOSAFAT
Middle Name:
Last Name:VARELA
Suffix:
Gender:M
Credentials:CCSS, EMT-I
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 130
Mailing Address - Street 2:
Mailing Address - City:SANTO DOMINGO PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87052-0130
Mailing Address - Country:US
Mailing Address - Phone:505-470-0748
Mailing Address - Fax:
Practice Address - Street 1:18 EAGLE CT
Practice Address - Street 2:
Practice Address - City:SANTO DOMINGO PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87052-1230
Practice Address - Country:US
Practice Address - Phone:505-470-0748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM04000277146M00000X
NM106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate