Provider Demographics
NPI:1326707589
Name:ARREDONDO, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ARREDONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 E WILLIAMS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5848
Mailing Address - Country:US
Mailing Address - Phone:951-588-2553
Mailing Address - Fax:
Practice Address - Street 1:940 E WILLIAMS ST STE 102
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5848
Practice Address - Country:US
Practice Address - Phone:951-588-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95124536163W00000X
CA95018072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse