Provider Demographics
NPI:1295814325
Name:ARELLANO, PETER DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DENNIS
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 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:707-251-3604
Mailing Address - Fax:707-251-1706
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 350
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2900
Practice Address - Country:US
Practice Address - Phone:707-251-3604
Practice Address - Fax:707-251-1706
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G698980Medicaid
CACA149862Medicare PIN
CA00G698980Medicaid