Provider Demographics
NPI:1376731257
Name:TRIPP, ARTURO (PA)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:
Last Name:TRIPP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3528
Mailing Address - Country:US
Mailing Address - Phone:951-354-3216
Mailing Address - Fax:951-848-9968
Practice Address - Street 1:9939 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3528
Practice Address - Country:US
Practice Address - Phone:951-687-8802
Practice Address - Fax:951-687-2250
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 14993363AM0700X
AZ3793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78444OtherMEDICARE GROUP
CAPA14993Medicaid
CAZZZ19972Z /ZZZ20075ZOtherMEDICARE GROUP
CAGR0083640/GR0083641OtherMEDICAL GROUP
AZ706393OtherAHCCCS GROUP
AZ706393OtherAHCCCS GROUP
CA0PA149931Medicare PIN