Basic Information
| Provider Information | |||||||||
| NPI: | 1376731257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRIPP | ||||||||
| FirstName: | ARTURO | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9939 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513543216 | ||||||||
| FaxNumber: | 9518489968 | ||||||||
| Practice Location | |||||||||
| Address1: | 9939 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516878802 | ||||||||
| FaxNumber: | 9516872250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA 14993 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 3793 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Z78444 | 01 | AZ | MEDICARE GROUP | OTHER | PA14993 | 05 | CA | MEDICAID | ZZZ19972Z /ZZZ20075Z | 01 | CA | MEDICARE GROUP | OTHER | GR0083640/GR0083641 | 01 | CA | MEDICAL GROUP | OTHER | 706393 | 01 | AZ | AHCCCS GROUP | OTHER |