Provider Demographics
NPI:1982358602
Name:ARELLANO, JACQUELINE ALYSSA (MPH, MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALYSSA
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:MPH, MPAS, PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WELLNESS PL APT 1835
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2349
Mailing Address - Country:US
Mailing Address - Phone:915-526-2376
Mailing Address - Fax:
Practice Address - Street 1:7424 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6309
Practice Address - Country:US
Practice Address - Phone:702-994-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant