Healthcare Provider Details

I. General information

NPI: 1285971028
Provider Name (Legal Business Name): GERARD C. ARCILLA MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

IV. Provider business mailing address

PO BOX 786
POWAY CA
92074-0786
US

V. Phone/Fax

Practice location:
  • Phone: 619-857-8831
  • Fax: 858-842-1255
Mailing address:
  • Phone: 619-857-8831
  • Fax: 858-842-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA48300
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA48300
License Number StateCA

VIII. Authorized Official

Name: DR. GERARD C ARCILLA
Title or Position: OWNER
Credential: MD
Phone: 619-857-8831