Provider Demographics
NPI:1891485942
Name:ARELLANO, JOAQUIN
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:ARELLANO
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:PO BOX 7026
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-0026
Mailing Address - Country:US
Mailing Address - Phone:510-269-9063
Mailing Address - Fax:
Practice Address - Street 1:25595 COMPTON CT APT 105
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2763
Practice Address - Country:US
Practice Address - Phone:415-990-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker