Healthcare Provider Details

I. General information

NPI: 1639089865
Provider Name (Legal Business Name): ARNA SUSAN VODENOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70941 VALERIE CIR
RANCHO MIRAGE CA
92270-2368
US

IV. Provider business mailing address

70941 VALERIE CIR
RANCHO MIRAGE CA
92270-2368
US

V. Phone/Fax

Practice location:
  • Phone: 310-614-5352
  • Fax:
Mailing address:
  • Phone: 319-614-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSB94027008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: