Basic Information
| Provider Information | |||||||||
| NPI: | 1386794881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARECHIGA | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | EDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9808 VENICE BLVD | ||||||||
| Address2: | #700 | ||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902322732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109453350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1920 MARENGO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900331317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232766470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 28932 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 225400000X | ASW73056 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1265520183 | 05 | CA | MEDICAID | 1306922554 | 05 | CA | MEDICAID | 1841342318 | 05 | CA | MEDICAID |