Provider Demographics
NPI:1639674583
Name:ARELLANO, GRISELDA
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:ARELLANO
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 1:751 RANCHEROS DR STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3042
Mailing Address - Country:US
Mailing Address - Phone:760-761-0515
Mailing Address - Fax:
Practice Address - Street 1:751 RANCHEROS DR STE 5
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3042
Practice Address - Country:US
Practice Address - Phone:760-761-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)