Healthcare Provider Details

I. General information

NPI: 1760613046
Provider Name (Legal Business Name): JULIE ANN ARELLANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 WHITELOCK PKWY STE 103
ELK GROVE CA
95757-5922
US

IV. Provider business mailing address

5650 WHITELOCK PKWY STE 130
ELK GROVE CA
95757-5927
US

V. Phone/Fax

Practice location:
  • Phone: 916-957-8771
  • Fax: 916-581-8794
Mailing address:
  • Phone: 248-952-7564
  • Fax: 916-581-8794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number170871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number308005
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301094677
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: