Healthcare Provider Details

I. General information

NPI: 1376034009
Provider Name (Legal Business Name): ARNALDO VIVANCO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVE STE 160-170
TURLOCK CA
95382-2706
US

IV. Provider business mailing address

9078 HILLSIDE RD
DELHI CA
95315-9338
US

V. Phone/Fax

Practice location:
  • Phone: 209-216-3300
  • Fax:
Mailing address:
  • Phone: 209-450-8993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: