Healthcare Provider Details

I. General information

NPI: 1104248087
Provider Name (Legal Business Name): JOSE ARIAS ACUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 ARMSTRONG ST
SAN DIEGO CA
92111-5702
US

IV. Provider business mailing address

3002 ARMSTRONG ST
SAN DIEGO CA
92111-5702
US

V. Phone/Fax

Practice location:
  • Phone: 858-633-2125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: