1154132223 NPI number — CARLOS OMAR ARBALLO DURAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154132223 NPI number — CARLOS OMAR ARBALLO DURAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS OMAR ARBALLO DURAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154132223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EDIFICIO MEDAC #22
Provider Second Line Business Mailing Address:
SUITE 101-B
Provider Business Mailing Address City Name:
TIJUANA
Provider Business Mailing Address State Name:
BAJA CALIFORNIA
Provider Business Mailing Address Postal Code:
22010
Provider Business Mailing Address Country Code:
MX
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO MEDAC #22
Provider Second Line Business Practice Location Address:
SUITE 101-B
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-308-7928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARBALLO DURAN
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
OMAR
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
619-308-7928

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)