Healthcare Provider Details

I. General information

NPI: 1356810469
Provider Name (Legal Business Name): ANA ARNAUTALIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69930 HIGHWAY 111 STE 201D
RANCHO MIRAGE CA
92270-2853
US

IV. Provider business mailing address

69930 HIGHWAY 111 STE 201D
RANCHO MIRAGE CA
92270-2853
US

V. Phone/Fax

Practice location:
  • Phone: 310-880-8036
  • Fax:
Mailing address:
  • Phone: 310-880-8036
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: