Provider Demographics
NPI:1619099447
Name:ARANGUREN, AUGUSTO IVAN (MS OTR/L CST C/NDT)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTO
Middle Name:IVAN
Last Name:ARANGUREN
Suffix:
Gender:M
Credentials:MS OTR/L CST C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42173
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-2173
Mailing Address - Country:US
Mailing Address - Phone:520-471-0283
Mailing Address - Fax:520-237-5182
Practice Address - Street 1:3920 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1917
Practice Address - Country:US
Practice Address - Phone:520-471-0283
Practice Address - Fax:520-327-5182
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4668225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ563398Medicaid
AZOTH-004668OtherAZ LICENSE