Provider Demographics
NPI:1902318314
Name:ARRIETA, ALEXANDER (SOIDMT, FP-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:ARRIETA
Suffix:
Gender:M
Credentials:SOIDMT, FP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INCIRLIK AB - 39TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 7096 BOX 185
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824
Mailing Address - Country:US
Mailing Address - Phone:325-232-0015
Mailing Address - Fax:
Practice Address - Street 1:INCIRLIK AB - 39TH MEDICAL GROUP
Practice Address - Street 2:UNIT 7096
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824-5185
Practice Address - Country:US
Practice Address - Phone:325-232-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL535230146L00000X
M5025927146L00000X
LALA15-013283146L00000X
1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic