Provider Demographics
NPI:1891428652
Name:ARQUISOLA, RENE
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:ARQUISOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11538 BOS ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6743
Mailing Address - Country:US
Mailing Address - Phone:562-335-8193
Mailing Address - Fax:
Practice Address - Street 1:11538 BOS ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6743
Practice Address - Country:US
Practice Address - Phone:562-335-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAV8087984172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty