Provider Demographics
NPI:1831197789
Name:ARBENZ, FREDERICK CHARLES (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CHARLES
Last Name:ARBENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 W STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2800
Mailing Address - Country:US
Mailing Address - Phone:760-337-1771
Mailing Address - Fax:760-337-1122
Practice Address - Street 1:1441 W STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2800
Practice Address - Country:US
Practice Address - Phone:760-337-1771
Practice Address - Fax:760-337-1122
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55316208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13131Medicare ID - Type Unspecified
A52927Medicare UPIN