Healthcare Provider Details

I. General information

NPI: 1285750471
Provider Name (Legal Business Name): IVAN ARALICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 AVENUE F
ELY NV
89301-2520
US

IV. Provider business mailing address

4126 TECHNOLOGY WAY SUITE 102
CARSON CITY NV
89706-2009
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-1671
  • Fax: 775-289-1699
Mailing address:
  • Phone: 775-687-7573
  • Fax: 775-687-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number3962
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: