Provider Demographics
NPI:1073295390
Name:ARNOLD, TRISTAN MALACHIE (CMT)
Entity Type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:MALACHIE
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 GOLDFINCH WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6642
Mailing Address - Country:US
Mailing Address - Phone:717-836-9406
Mailing Address - Fax:
Practice Address - Street 1:318 N HORNE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2810
Practice Address - Country:US
Practice Address - Phone:717-836-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist