Healthcare Provider Details

I. General information

NPI: 1720243033
Provider Name (Legal Business Name): MR. EDUARDO ALONSO ARMENDARIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S QUINTANA DR
ANAHEIM CA
92807-4029
US

IV. Provider business mailing address

233 S QUINTANA DR
ANAHEIM CA
92807-4029
US

V. Phone/Fax

Practice location:
  • Phone: 714-988-9822
  • Fax:
Mailing address:
  • Phone: 714-988-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-RIJYUF
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: