Provider Demographics
NPI:1568923886
Name:ARNOLD, GARY EDWIN (CADAC11)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:EDWIN
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:CADAC11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2852
Mailing Address - Country:US
Mailing Address - Phone:619-791-2730
Mailing Address - Fax:
Practice Address - Street 1:2300 E 7TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2852
Practice Address - Country:US
Practice Address - Phone:619-791-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII059650618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)