Healthcare Provider Details

I. General information

NPI: 1730271933
Provider Name (Legal Business Name): ARTHUR RAY MABAQUIAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CAMINO DE LA SIESTA STE 106
SAN DIEGO CA
92108-3117
US

IV. Provider business mailing address

PO BOX 511491
LOS ANGELES CA
90051-8046
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-4869
  • Fax: 619-334-4940
Mailing address:
  • Phone: 866-284-2771
  • Fax: 822-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number207RR0500X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: