MEDICARE: JORGE ARENIVAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	667295	TX
2	163WC0400X	Case Management Registered Nurse	667295	TX

General Provider Information

NPI Number	:	1063809788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ARENIVAR

Provider Business Mailing Address
First Line	:	11805 LONGWOOD GARDEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4435
Country	:	US
Telephone Number	:	409-771-0059
Fax Number	:

Provider Business Practice Location Address
First Line	:	11805 LONGWOOD GARDEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4435
Country	:	US
Telephone Number	:	409-771-0059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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Directions to “ JORGE ARENIVAR ” Practice Location

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