Healthcare Provider Details

I. General information

NPI: 1912557018
Provider Name (Legal Business Name): CRISTIAN SAMIR MARTINEZ ARELLANO RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 S WEST ST
TULARE CA
93274-3411
US

IV. Provider business mailing address

2515 E HAROLD CT
VISALIA CA
93292-8001
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH32977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: