Provider Demographics
NPI:1215034590
Name:PORTABLE PRACTICAL EDUCATION PREPARATION INC.
Entity type:Organization
Organization Name:PORTABLE PRACTICAL EDUCATION PREPARATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-622-3553
Mailing Address - Street 1:802 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5006
Mailing Address - Country:US
Mailing Address - Phone:520-622-3553
Mailing Address - Fax:520-622-1480
Practice Address - Street 1:111 LA MINA AVE
Practice Address - Street 2:ROOM 5
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321-2716
Practice Address - Country:US
Practice Address - Phone:520-387-5232
Practice Address - Fax:520-387-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH387261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134966Medicaid