=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942569553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA ELENA ARREDONDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2012
-----------------------------------------------------
Last Update Date | 05/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5712 COLDBROOK AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90713-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-762-6333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5712 COLDBROOK AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90713-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-762-6333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA15147
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------