Provider Demographics
NPI:1629504071
Name:MISTICA, ARLA MA (MD)
Entity Type:Individual
Prefix:
First Name:ARLA
Middle Name:MA
Last Name:MISTICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:555 PACIFIC AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1903
Mailing Address - Country:US
Mailing Address - Phone:307-331-6509
Mailing Address - Fax:
Practice Address - Street 1:1356 LUSITANA ST FL 4
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2409
Practice Address - Country:US
Practice Address - Phone:808-586-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611610152084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program