Basic Information
Provider Information
NPI: 1811965007
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARELLANO
FirstName: UBALDO
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: RKT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 804 LEONARD ST
Address2:  
City: MONTEBELLO
State: CA
PostalCode: 906401518
CountryCode: US
TelephoneNumber: 5628268000
FaxNumber:  
Practice Location
Address1: 5901 E 7TH ST
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908225201
CountryCode: US
TelephoneNumber: 5628268000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/14/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
226300000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist 

No ID Information.


Home