Healthcare Provider Details

I. General information

NPI: 1518820315
Provider Name (Legal Business Name): JETHRO ARELLANO LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 CASTLE VALLEY AVE
LAS VEGAS NV
89178-7580
US

IV. Provider business mailing address

9197 CASTLE VALLEY AVE
LAS VEGAS NV
89178-7580
US

V. Phone/Fax

Practice location:
  • Phone: 702-541-3366
  • Fax:
Mailing address:
  • Phone: 702-541-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number890674
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: