Provider Demographics
NPI:1285659284
Name:ARELLANO, JESSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:ARELLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 S DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1216
Mailing Address - Country:US
Mailing Address - Phone:805-349-8514
Mailing Address - Fax:805-349-8958
Practice Address - Street 1:2271 S DEPOT ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1216
Practice Address - Country:US
Practice Address - Phone:805-349-8514
Practice Address - Fax:805-349-8958
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70693FOtherFAMILY PLANNING
CAHC596ZOtherMEDICARE ID
CAFHC70693FMedicaid
CA551904Medicare Oscar/Certification
CAWA75520DMedicare PIN
CAFHC70693FMedicaid
CAH60654Medicare UPIN
CAW1508Medicare PIN