Provider Demographics
NPI:1093080590
Name:ARCE, BERNALIZA LABAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNALIZA
Middle Name:LABAN
Last Name:ARCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BERNALIZA
Other - Middle Name:ARCE
Other - Last Name:REVILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-1368
Mailing Address - Country:US
Mailing Address - Phone:760-572-4100
Mailing Address - Fax:760-572-2113
Practice Address - Street 1:401 PICACHO ROAD
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283
Practice Address - Country:US
Practice Address - Phone:760-572-4100
Practice Address - Fax:760-572-2113
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR018281261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care