Healthcare Provider Details

I. General information

NPI: 1174787931
Provider Name (Legal Business Name): MARIA ROXANNE AILEEN VENTENILLA ARCINUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROXANNE ARCINUE

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 CLARK ST
TARZANA CA
91356-3501
US

IV. Provider business mailing address

3701 WILSHIRE BLVD STE 600
LOS ANGELES CA
90010-2804
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-0800
  • Fax:
Mailing address:
  • Phone: 323-361-2337
  • Fax: 323-361-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57013888
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA112597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: