Healthcare Provider Details

I. General information

NPI: 1679115299
Provider Name (Legal Business Name): ARLIN MARIE LLIDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 VENICE BLVD
LOS ANGELES CA
90034-3216
US

IV. Provider business mailing address

12411 W FIELDING CIR APT 5544
PLAYA VISTA CA
90094-2662
US

V. Phone/Fax

Practice location:
  • Phone: 310-237-0023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008530
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95008530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: