Healthcare Provider Details

I. General information

NPI: 1528029881
Provider Name (Legal Business Name): ANDRES COSTAS ARANDA IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 GUADALCANAL ST
SAN DIEGO CA
92134
US

IV. Provider business mailing address

3213 32ND ST
SAN DIEGO CA
92104-4701
US

V. Phone/Fax

Practice location:
  • Phone: 691-524-8397
  • Fax:
Mailing address:
  • Phone: 619-546-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: