Provider Demographics
NPI:1376120634
Name:IRAHETA, ARMANDO ANTONIO JR
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:ANTONIO
Last Name:IRAHETA
Suffix:JR
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 1:706 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4810
Mailing Address - Country:US
Mailing Address - Phone:909-730-6426
Mailing Address - Fax:
Practice Address - Street 1:706 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4810
Practice Address - Country:US
Practice Address - Phone:909-730-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver