Healthcare Provider Details

I. General information

NPI: 1588795371
Provider Name (Legal Business Name): ARQUILIO CERDA JR. BSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S. 'L' STREET
DINUBA CA
93618
US

IV. Provider business mailing address

1644 N TIPTON ST
VISALIA CA
93292-2106
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-6680
  • Fax:
Mailing address:
  • Phone: 559-308-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: