Healthcare Provider Details

I. General information

NPI: 1225212202
Provider Name (Legal Business Name): ENA ANDREA ARCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39155 LIBERTY ST STE D470
FREMONT CA
94538-1529
US

IV. Provider business mailing address

39155 LIBERTY STREET SUITE D470
FREMONT CA
94538
US

V. Phone/Fax

Practice location:
  • Phone: 510-795-2409
  • Fax: 510-792-8744
Mailing address:
  • Phone: 510-795-2409
  • Fax: 510-792-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number583812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: