Provider Demographics
NPI:1396412888
Name:ABBIDO, ARTHURO RECTO
Entity Type:Individual
Prefix:
First Name:ARTHURO
Middle Name:RECTO
Last Name:ABBIDO
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:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:CHELAN FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98817-0204
Mailing Address - Country:US
Mailing Address - Phone:925-812-2066
Mailing Address - Fax:
Practice Address - Street 1:545 3RD ST
Practice Address - Street 2:
Practice Address - City:CHELAN FALLS
Practice Address - State:WA
Practice Address - Zip Code:98817
Practice Address - Country:US
Practice Address - Phone:925-812-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAAP61214940363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program