Provider Demographics
NPI:1336527498
Name:ARBAN, WILFREDO TOMAS
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:TOMAS
Last Name:ARBAN
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 1:3045 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5837
Mailing Address - Country:US
Mailing Address - Phone:323-587-7771
Mailing Address - Fax:323-587-8310
Practice Address - Street 1:3045 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5837
Practice Address - Country:US
Practice Address - Phone:323-587-7771
Practice Address - Fax:323-587-8310
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-09
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily