Provider Demographics
NPI:1205569050
Name:IKEDA, AARON ARTHUR HIRO
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:ARTHUR HIRO
Last Name:IKEDA
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 1:3562 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4752
Mailing Address - Country:US
Mailing Address - Phone:559-905-5797
Mailing Address - Fax:
Practice Address - Street 1:3562 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4752
Practice Address - Country:US
Practice Address - Phone:559-905-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician