Provider Demographics
NPI:1790885259
Name:ARANO, VICENTE JAVELLANA (M D)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:JAVELLANA
Last Name:ARANO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57445 29-PALMS HIGHWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2947
Mailing Address - Country:US
Mailing Address - Phone:760-369-1262
Mailing Address - Fax:760-369-1253
Practice Address - Street 1:57445 29-PALMS HIGHWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2947
Practice Address - Country:US
Practice Address - Phone:760-369-1262
Practice Address - Fax:760-369-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A556580Medicaid
CA00A556580Medicaid
NJG15859Medicare UPIN
CA00A556580Medicare ID - Type Unspecified