Provider Demographics
NPI:1063525319
Name:PENALOZA ARANIBAR, CARLOS G (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:G
Last Name:PENALOZA ARANIBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-1330
Mailing Address - Country:US
Mailing Address - Phone:609-965-8063
Mailing Address - Fax:609-965-7771
Practice Address - Street 1:227 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-1330
Practice Address - Country:US
Practice Address - Phone:609-965-8063
Practice Address - Fax:609-965-7771
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3998207Medicaid
D06859Medicare UPIN
NJ002585CN9Medicare PIN