Provider Demographics
NPI:1205846383
Name:ARCIAGA, RANDY LAUCHENGCO
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LAUCHENGCO
Last Name:ARCIAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 STRATUS LN
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-6521
Mailing Address - Country:US
Mailing Address - Phone:949-331-8803
Mailing Address - Fax:
Practice Address - Street 1:65 STRATUS LN
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-6521
Practice Address - Country:US
Practice Address - Phone:949-331-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist