Provider Demographics
NPI:1831771955
Name:ARIAS, VICENTE AMADEO
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:AMADEO
Last Name:ARIAS
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 1:8628 MESA OAK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-3167
Mailing Address - Country:US
Mailing Address - Phone:951-275-2676
Mailing Address - Fax:
Practice Address - Street 1:8628 MESA OAK DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-3167
Practice Address - Country:US
Practice Address - Phone:951-275-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner