Basic Information
Provider Information
NPI: 1407500580
EntityType: 2
ReplacementNPI:  
OrganizationName: ARELLANO MEDICAL CLINIC LLC
LastName:  
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Mailing Information
Address1: 3106 E INGLE RD
Address2:  
City: EDINBURG
State: TX
PostalCode: 785421402
CountryCode: US
TelephoneNumber: 9562629661
FaxNumber:  
Practice Location
Address1: 504 W EDINBURG AVE
Address2:  
City: ELSA
State: TX
PostalCode: 785433008
CountryCode: US
TelephoneNumber: 9562629661
FaxNumber: 9562629664
Other Information
ProviderEnumerationDate: 02/08/2022
LastUpdateDate: 02/08/2022
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: ARELLANO
AuthorizedOfficialFirstName: SALVADOR
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AuthorizedOfficialTitleorPosition: OWNER/PHYSICIAN ASSISTANT
AuthorizedOfficialTelephone: 9562629661
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix: JR.
AuthorizedOfficialCredential: PHYSICIAN ASSISTANT
NPICertificationDate: 01/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  Y193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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