Healthcare Provider Details

I. General information

NPI: 1679108344
Provider Name (Legal Business Name): MIKAELA ARREDONDO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 BROADWAY STE 13
SOUTH PORTLAND ME
04106-4371
US

IV. Provider business mailing address

884 BROADWAY STE 13
SOUTH PORTLAND ME
04106-4371
US

V. Phone/Fax

Practice location:
  • Phone: 971-808-3479
  • Fax: 855-955-3928
Mailing address:
  • Phone: 971-808-3479
  • Fax: 855-955-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4297
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: