Healthcare Provider Details

I. General information

NPI: 1508519661
Provider Name (Legal Business Name): ARJIE ALEA FLORENTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 E IMPERIAL HWY
LYNWOOD CA
90262-2654
US

IV. Provider business mailing address

3585 E IMPERIAL HWY
LYNWOOD CA
90262-2654
US

V. Phone/Fax

Practice location:
  • Phone: 310-605-4260
  • Fax: 310-605-4263
Mailing address:
  • Phone: 310-605-4260
  • Fax: 310-605-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA62403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: