Provider Demographics
NPI:1508519661
Name:FLORENTINO, ARJIE ALEA
Entity Type:Individual
Prefix:
First Name:ARJIE
Middle Name:ALEA
Last Name:FLORENTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5518 PIERCY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1464
Mailing Address - Country:US
Mailing Address - Phone:562-357-2881
Mailing Address - Fax:
Practice Address - Street 1:3585 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2654
Practice Address - Country:US
Practice Address - Phone:310-605-4260
Practice Address - Fax:310-605-4263
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
CAPA62403363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical