Provider Demographics
NPI:1619016847
Name:ARELLANO, JOSEPH RUIZ (LMP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RUIZ
Last Name:ARELLANO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4091
Mailing Address - Country:US
Mailing Address - Phone:360-293-0927
Mailing Address - Fax:360-588-1717
Practice Address - Street 1:1300 O AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2187
Practice Address - Country:US
Practice Address - Phone:360-293-0927
Practice Address - Fax:360-588-1717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist