Provider Demographics
NPI:1437269834
Name:ARCILLA, JUANITA RIVERA (MD)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:RIVERA
Last Name:ARCILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6829B NAVIGATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011
Mailing Address - Country:US
Mailing Address - Phone:832-649-2347
Mailing Address - Fax:832-767-0888
Practice Address - Street 1:6829B NAVIGATION BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-1452
Practice Address - Country:US
Practice Address - Phone:832-649-2347
Practice Address - Fax:832-767-0888
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9562208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162228401Medicaid
TX162228402OtherTHSTEPS
TX126492106Medicaid
TXB20951Medicare UPIN
TXP00205958Medicare ID - Type UnspecifiedRAILROAD PART BPROVIDER I
TX80E328Medicare ID - Type UnspecifiedPART B PROVIDER ID
TX126492106Medicaid