Provider Demographics
NPI:1952858417
Name:ARIAS, RAFAEL
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:ARIAS
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 1:12386 17TH ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1554
Mailing Address - Country:US
Mailing Address - Phone:909-521-2558
Mailing Address - Fax:
Practice Address - Street 1:12386 17TH ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399
Practice Address - Country:US
Practice Address - Phone:909-521-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF1428527343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)