Healthcare Provider Details

I. General information

NPI: 1720484652
Provider Name (Legal Business Name): ARVIN JENAB N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 SORRENTO VALLEY BLVD
SAN DIEGO CA
92121-1429
US

IV. Provider business mailing address

4110 SORRENTO VALLEY BLVD
SAN DIEGO CA
92121-1429
US

V. Phone/Fax

Practice location:
  • Phone: 858-246-9730
  • Fax: 858-246-9710
Mailing address:
  • Phone: 858-246-9730
  • Fax: 858-246-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: