Provider Demographics
NPI: | 1861821977 |
---|---|
Name: | ARAYA MEDICINE INC |
Entity Type: | Organization |
Organization Name: | ARAYA MEDICINE INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | CLETO |
Authorized Official - Last Name: | ARAYA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 805-801-6254 |
Mailing Address - Street 1: | 469 S HOLT AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90048-4016 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 805-801-6254 |
Mailing Address - Fax: | 702-453-5741 |
Practice Address - Street 1: | 85 SIERRA PARK RD |
Practice Address - Street 2: | |
Practice Address - City: | MAMMOTH LAKES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93546-2073 |
Practice Address - Country: | US |
Practice Address - Phone: | 805-801-6254 |
Practice Address - Fax: | 702-453-5741 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-11-08 |
Last Update Date: | 2013-11-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A71579 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |