Healthcare Provider Details

I. General information

NPI: 1083365647
Provider Name (Legal Business Name): SERGIO ANTONIO ARRIOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 01/15/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 OCEAN SIDE DR
EL PASO TX
79936-3652
US

IV. Provider business mailing address

6836 TOLUCA DR
EL PASO TX
79912-1716
US

V. Phone/Fax

Practice location:
  • Phone: 915-315-1743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: