Provider Demographics
NPI:1225063555
Name:WELCH, MARK ARNOLD (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ARNOLD
Last Name:WELCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7132 DAYBREAK PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6302
Mailing Address - Country:US
Mailing Address - Phone:951-966-5802
Mailing Address - Fax:
Practice Address - Street 1:11374 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3830
Practice Address - Country:US
Practice Address - Phone:909-558-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA89502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2OA89500OtherMEDICARE NUMBER