Provider Demographics
NPI:1477739712
Name:ARELLANO, MARIO A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:A
Last Name:ARELLANO
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 1:1053 VOLCANO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1615
Mailing Address - Country:US
Mailing Address - Phone:619-934-5337
Mailing Address - Fax:
Practice Address - Street 1:101 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5802
Practice Address - Country:US
Practice Address - Phone:619-562-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10672T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist