Healthcare Provider Details

I. General information

NPI: 1497595094
Provider Name (Legal Business Name): DAVID MARCOS ARELLANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 BLACKSTONE CT
EL PASO TX
79922-1209
US

IV. Provider business mailing address

4133 BLACKSTONE CT
EL PASO TX
79922-1209
US

V. Phone/Fax

Practice location:
  • Phone: 915-231-8744
  • Fax:
Mailing address:
  • Phone: 915-231-8744
  • 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: