Provider Demographics
NPI:1386170413
Name:VARON, ADYLLE (LAC)
Entity type:Individual
Prefix:
First Name:ADYLLE
Middle Name:
Last Name:VARON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 SHORE DISTRICT DR
Mailing Address - Street 2:APARTMENT 1355
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1300
Mailing Address - Country:US
Mailing Address - Phone:832-283-8845
Mailing Address - Fax:
Practice Address - Street 1:1333 SHORE DISTRICT DR
Practice Address - Street 2:APARTMENT 1355
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1300
Practice Address - Country:US
Practice Address - Phone:832-283-8845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist