Provider Demographics
NPI:1730745613
Name:ALFREDO H ARELLANO PMHCNS-BC PA
Entity type:Organization
Organization Name:ALFREDO H ARELLANO PMHCNS-BC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS-BC
Authorized Official - Phone:915-307-5796
Mailing Address - Street 1:1122 MONTANA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5510
Mailing Address - Country:US
Mailing Address - Phone:915-307-5796
Mailing Address - Fax:915-307-5822
Practice Address - Street 1:1122 MONTANA AVE STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5510
Practice Address - Country:US
Practice Address - Phone:915-307-5796
Practice Address - Fax:915-307-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX428152901Medicaid