MEDICARE: DR. CYNTHIA ARATA LO O.D.

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	152W00000X	Optometrist	13295	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTAN - WY5748	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1073711461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA ARATA LO O.D.

Provider Business Mailing Address
First Line	:	5792 SHIRL ST
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-3325
Country	:	US
Telephone Number	:	714-220-8698
Fax Number	:

Provider Business Practice Location Address
First Line	:	12461 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5511
Country	:	US
Telephone Number	:	310-390-6287
Fax Number	:

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	02/08/2021

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