Provider Demographics
NPI:1659501880
Name:ARELLANES, CAROLYN L (PA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:ARELLANES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:DIKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1600 WEEOT WAY
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4734
Mailing Address - Country:US
Mailing Address - Phone:707-825-5000
Mailing Address - Fax:707-825-6747
Practice Address - Street 1:501 N INDIAN RD
Practice Address - Street 2:
Practice Address - City:SMITH RIVER
Practice Address - State:CA
Practice Address - Zip Code:95567-9509
Practice Address - Country:US
Practice Address - Phone:707-487-0215
Practice Address - Fax:707-487-3003
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant