Healthcare Provider Details

I. General information

NPI: 1558064402
Provider Name (Legal Business Name): CARLOS ANGELO SIA ARANZANSO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13039 BLODGETT AVE
DOWNEY CA
90242-4512
US

IV. Provider business mailing address

13039 BLODGETT AVE
DOWNEY CA
90242-4512
US

V. Phone/Fax

Practice location:
  • Phone: 424-337-2373
  • Fax:
Mailing address:
  • Phone: 424-337-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: