MEDICARE: MR. ARVIN ANABO P.A.-C

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	363AM0700X	Medical Physician Assistant	16689	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16689	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1306051008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARVIN ANABO P.A.-C

Provider Business Mailing Address
First Line	:	10399 LEMON AVE STE 101
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3771
Country	:	US
Telephone Number	:	909-373-0216
Fax Number	:	909-373-1902

Provider Business Practice Location Address
First Line	:	10399 LEMON AVE STE 101
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3771
Country	:	US
Telephone Number	:	909-373-0216
Fax Number	:	909-373-1902

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/16/2023

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