Healthcare Provider Details

I. General information

NPI: 1134312366
Provider Name (Legal Business Name): RANDAL PAUL ARASE MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ALVARADO ST #716
LOS ANGELES CA
90057-2392
US

IV. Provider business mailing address

201 S ALVARADO ST #716
LOS ANGELES CA
90057-2392
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-2000
  • Fax: 213-484-9716
Mailing address:
  • Phone: 213-484-2000
  • Fax: 213-484-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA25418
License Number StateCA

VIII. Authorized Official

Name: RANDAL P ARASE
Title or Position: PRESIDENT
Credential: MD
Phone: 213-484-2000