Provider Demographics
NPI:1467594093
Name:ARREDONDO, ALEJANDRO MIGUEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:MIGUEL
Last Name:ARREDONDO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 SATURN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4142
Mailing Address - Country:US
Mailing Address - Phone:323-583-7900
Mailing Address - Fax:323-583-7869
Practice Address - Street 1:2675 SATURN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4142
Practice Address - Country:US
Practice Address - Phone:323-583-7900
Practice Address - Fax:323-583-7869
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8658T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086582Medicaid
CASD0086581Medicaid
CAOP8658AMedicare ID - Type UnspecifiedPROVIDER# FOR MEDICARE
CASD0086582Medicaid
CADW105ZMedicare PIN