1518314616 NPI number — ARLIZBETH ESTRADA ARIZANGA LUNA NURSE PRACTITIONER

Table of content: ARLIZBETH ESTRADA ARIZANGA LUNA NURSE PRACTITIONER (NPI 1518314616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518314616 NPI number — ARLIZBETH ESTRADA ARIZANGA LUNA NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARIZANGA LUNA
Provider First Name:
ARLIZBETH
Provider Middle Name:
ESTRADA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

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:
1518314616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5230 PACIFIC CONCOURSE DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-6279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-297-9221
Provider Business Mailing Address Fax Number:
310-297-9222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5230 PACIFIC CONCOURSE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-297-9221
Provider Business Practice Location Address Fax Number:
310-297-9222
Provider Enumeration Date:
05/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  95004246 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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