Provider Demographics
NPI:1265642052
Name:ARCINIEGA, JOSE I (DO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:I
Last Name:ARCINIEGA
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2915
Mailing Address - Fax:
Practice Address - Street 1:17051 SIERRA LAKES PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1274
Practice Address - Country:US
Practice Address - Phone:909-428-2040
Practice Address - Fax:909-428-2191
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174760953Medicaid
CAP00613389OtherRR MCR
CA20A10123OtherBS/TRIWEST
CA1265642052Medicaid
CACQ2267OtherRR MCR
CAP00613389Medicare PIN
020A101230Medicare PIN
CAP00613389OtherRR MCR
CA1265642052Medicaid
CACD332Medicare PIN