Basic Information
Provider Information | |||||||||
NPI: | 1366757692 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VARAS GARCIA | ||||||||
FirstName: | SEBASTIAN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VARAS | ||||||||
OtherFirstName: | SEBASTIAN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 602 E NOB HILL BLVD | ||||||||
Address2: |   | ||||||||
City: | YAKIMA | ||||||||
State: | WA | ||||||||
PostalCode: | 989013534 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5092483334 | ||||||||
FaxNumber: | 5094536144 | ||||||||
Practice Location | |||||||||
Address1: | 410 BIRCHWOOD AVE STE 200 | ||||||||
Address2: |   | ||||||||
City: | BELLINGHAM | ||||||||
State: | WA | ||||||||
PostalCode: | 982251783 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3607349233 | ||||||||
FaxNumber: | 3607388974 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/11/2010 | ||||||||
LastUpdateDate: | 04/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 243429 | MA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD60602339 | WA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RN0300X | EC131052 | ME | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | MD60602339 | WA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 1366757692 | 05 | WA |   | MEDICAID |