Provider Demographics
NPI:1295460806
Name:ARELLANO, MIGUEL (NP)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:ARELLANO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4014
Mailing Address - Country:US
Mailing Address - Phone:213-509-1469
Mailing Address - Fax:
Practice Address - Street 1:1848 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4014
Practice Address - Country:US
Practice Address - Phone:213-509-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty