Healthcare Provider Details

I. General information

NPI: 1770317331
Provider Name (Legal Business Name): ARVIN E IGNACIO OTR/L, CGCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3034 E HERNDON AVE
FRESNO CA
93720-0300
US

IV. Provider business mailing address

3544 RICHMOND AVE
CLOVIS CA
93619-8035
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-0883
  • Fax:
Mailing address:
  • Phone: 815-272-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: