Provider Demographics
NPI:1134827892
Name:ARELLANO, JAMES PAUL (MSOM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PAUL
Last Name:ARELLANO
Suffix:
Gender:M
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 SE 33RD PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3440
Mailing Address - Country:US
Mailing Address - Phone:503-758-5407
Mailing Address - Fax:
Practice Address - Street 1:1540 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1130
Practice Address - Country:US
Practice Address - Phone:503-914-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC213899171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist