Healthcare Provider Details

I. General information

NPI: 1902318314
Provider Name (Legal Business Name): ALEXANDER ARRIETA SOIDMT, FP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 12/01/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INCIRLIK AB - 39TH MEDICAL GROUP UNIT 7096
APO AE
09824-5185
US

IV. Provider business mailing address

INCIRLIK AB - 39TH MEDICAL GROUP UNIT 7096 BOX 185
APO AE
09824
US

V. Phone/Fax

Practice location:
  • Phone: 325-232-0015
  • Fax:
Mailing address:
  • Phone: 325-232-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number535230
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM5025927
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberLA15-013283
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: