Healthcare Provider Details

I. General information

NPI: 1457175952
Provider Name (Legal Business Name): ANJELICA ARELLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24050 ALISO CREEK RD
LAGUNA NIGUEL CA
92677-3950
US

IV. Provider business mailing address

145 HUNTINGTON
IRVINE CA
92620-3791
US

V. Phone/Fax

Practice location:
  • Phone: 949-317-4454
  • Fax:
Mailing address:
  • Phone: 909-914-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number53609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: