Healthcare Provider Details

I. General information

NPI: 1104484286
Provider Name (Legal Business Name): DIANA OLIVIA ARELLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 NORTHPARK CT
JOHNSTON IA
50131-3018
US

IV. Provider business mailing address

8835 NORTHPARK CT
JOHNSTON IA
50131-3018
US

V. Phone/Fax

Practice location:
  • Phone: 847-306-9843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: