Healthcare Provider Details

I. General information

NPI: 1629893110
Provider Name (Legal Business Name): JUSTIN DONALDO ARREOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5048 N JACKSON AVE M/S LS138
FRESNO CA
93740-0001
US

IV. Provider business mailing address

5048 N JACKSON AVE M/S LS 138
FRESNO CA
93740-0001
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-2757
  • Fax: 559-278-0016
Mailing address:
  • Phone: 559-278-6779
  • Fax: 559-278-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: