Healthcare Provider Details

I. General information

NPI: 1568721934
Provider Name (Legal Business Name): TAMANTHA SUE ARLATA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 08/16/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 CUYAMACA ST STE 101
SANTEE CA
92071-2692
US

IV. Provider business mailing address

9600 CUYAMACA ST STE 101
SANTEE CA
92071-2692
US

V. Phone/Fax

Practice location:
  • Phone: 619-749-2150
  • Fax: 619-456-9744
Mailing address:
  • Phone: 619-749-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA155040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: