MEDICARE: MARIA ALEJANDRA ARITA

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	106S00000X	Behavior Technician	18-48062	CA
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1295238855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ALEJANDRA ARITA

Provider Business Mailing Address
First Line	:	3601 PACIFIC AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95211-0110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 PACIFIC AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95211-8119
Country	:	US
Telephone Number	:	209-405-8649
Fax Number	:

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	12/26/2023

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