MEDICARE: DALENE ARIZMENDI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9119621	FL

General Provider Information

NPI Number	:	1891596516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALENE ARIZMENDI

Provider Business Mailing Address
First Line	:	2413 ROANOKE SPRINGS DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-6335
Country	:	US
Telephone Number	:	224-523-1310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 ROANOKE SPRINGS DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-6335
Country	:	US
Telephone Number	:	224-523-1310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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