Provider Demographics
NPI:1720308612
Name:GINESTA, ARLENNE (MD)
Entity Type:Individual
Prefix:
First Name:ARLENNE
Middle Name:
Last Name:GINESTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARLENNE
Other - Middle Name:
Other - Last Name:SHAPOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:41002 COUNTY CENTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6027
Mailing Address - Country:US
Mailing Address - Phone:951-600-6355
Mailing Address - Fax:951-600-6365
Practice Address - Street 1:41002 COUNTY CENTER DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6051
Practice Address - Country:US
Practice Address - Phone:951-600-6355
Practice Address - Fax:951-600-6365
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1242662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720308612OtherNONE