Provider Demographics
NPI:1538155932
Name:ARELLANO, ALVIN (OD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:ARELLANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 W MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2177
Mailing Address - Country:US
Mailing Address - Phone:714-992-8020
Mailing Address - Fax:714-992-8021
Practice Address - Street 1:1909 W MALVERN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2177
Practice Address - Country:US
Practice Address - Phone:714-992-8020
Practice Address - Fax:714-992-8021
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11040T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0011040Medicaid
CAWOP11040CMedicare PIN
CAU71946Medicare UPIN