Healthcare Provider Details

I. General information

NPI: 1740912187
Provider Name (Legal Business Name): MR. JAIME ARRIOLA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E YANDELL DR STE 104
EL PASO TX
79903-3751
US

IV. Provider business mailing address

7216 DALE RD APT 1
EL PASO TX
79915-2430
US

V. Phone/Fax

Practice location:
  • Phone: 915-990-2605
  • Fax:
Mailing address:
  • Phone: 915-731-4050
  • Fax: 915-206-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number228379
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: