Provider Demographics
NPI:1902911241
Name:ARECHABALETA, JOSU
Entity Type:Individual
Prefix:
First Name:JOSU
Middle Name:
Last Name:ARECHABALETA
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 1:622 N RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6023
Mailing Address - Country:US
Mailing Address - Phone:954-989-9145
Mailing Address - Fax:
Practice Address - Street 1:20601 E DIXIE HWY STE 300
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1542
Practice Address - Country:US
Practice Address - Phone:305-933-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36827OtherLICENSE #