Healthcare Provider Details

I. General information

NPI: 1023200409
Provider Name (Legal Business Name): MASSIMO ARCERITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21634 RETREAT PKWY
CORONA CA
92883-6100
US

IV. Provider business mailing address

21634 RETREAT PKWY
CORONA CA
92883-6100
US

V. Phone/Fax

Practice location:
  • Phone: 951-278-8870
  • Fax: 951-278-8913
Mailing address:
  • Phone: 951-278-8870
  • Fax: 951-278-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301098091
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA111450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: