Healthcare Provider Details

I. General information

NPI: 1245372366
Provider Name (Legal Business Name): JERRY L. ARELLANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 ELM ST NE
ALBUQUERQUE NM
87102-2512
US

IV. Provider business mailing address

PO BOX 8387
ALBUQUERQUE NM
87198-8387
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1000
  • Fax: 505-843-2853
Mailing address:
  • Phone: 505-841-1000
  • Fax: 505-843-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number228765
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD2009-0446
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: