=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932964236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BELENDA ARELLANES MARAVILLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2024
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3187 SWAN AVE
-----------------------------------------------------
City | SANGER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93657-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-955-6976
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 S K ST
-----------------------------------------------------
City | TULARE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93274-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-609-2128
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 1003007352
-----------------------------------------------------
License Number State |
-----------------------------------------------------