=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225212202
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ENA ANDREA ARCE RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 12/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39155 LIBERTY ST STE D470
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-795-2409
-----------------------------------------------------
Fax | 510-792-8744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39155 LIBERTY STREET SUITE D470
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-795-2409
-----------------------------------------------------
Fax | 510-792-8744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number | 583812
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------