Healthcare Provider Details

I. General information

NPI: 1871415422
Provider Name (Legal Business Name): MRS. JACQUELINE ARELLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GRACE AVE
INGLEWOOD CA
90301-1306
US

IV. Provider business mailing address

424 W 55TH ST
LOS ANGELES CA
90037-4002
US

V. Phone/Fax

Practice location:
  • Phone: 323-603-9863
  • Fax:
Mailing address:
  • Phone: 323-603-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number145E809DD2
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: