Healthcare Provider Details

I. General information

NPI: 1710446315
Provider Name (Legal Business Name): CONNOR ARELLANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 661-916-7904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16736
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: