Provider Demographics
NPI:1780863134
Name:ARRIOLA, CARMEN LILLIAN (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LILLIAN
Last Name:ARRIOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMELITA
Other - Middle Name:LILLIAN
Other - Last Name:ARRIOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5201 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92617-3096
Mailing Address - Country:US
Mailing Address - Phone:949-824-8685
Mailing Address - Fax:949-824-3515
Practice Address - Street 1:5201 CALIFORNIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-3096
Practice Address - Country:US
Practice Address - Phone:949-824-8685
Practice Address - Fax:949-824-3515
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63500207Q00000X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE09869Medicare UPIN