Provider Demographics
NPI:1689831794
Name:FARGAS-RODRIGUEZ, ARNALDO (PMHNP-BC, LMHC)
Entity Type:Individual
Prefix:
First Name:ARNALDO
Middle Name:
Last Name:FARGAS-RODRIGUEZ
Suffix:
Gender:M
Credentials:PMHNP-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:480-820-5422
Mailing Address - Fax:480-820-5422
Practice Address - Street 1:1255 W BASELINE RD STE 138A
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5821
Practice Address - Country:US
Practice Address - Phone:480-820-5422
Practice Address - Fax:480-820-5422
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10986101YM0800X
171M00000X
FLARNP9358067363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator