Provider Demographics
NPI:1548705536
Name:MARTIN ARELLANO M.D., P.C.
Entity type:Organization
Organization Name:MARTIN ARELLANO M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTITIONER & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-274-6463
Mailing Address - Street 1:2040 W BETHANY HOME RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2473
Mailing Address - Country:US
Mailing Address - Phone:602-274-6463
Mailing Address - Fax:602-249-1282
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2473
Practice Address - Country:US
Practice Address - Phone:602-274-6463
Practice Address - Fax:602-249-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21636405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ198839Medicaid