Provider Demographics
NPI:1285907469
Name:ARCINIEGA, KELLY ANNE (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:ARCINIEGA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:LLUMC ROOM 6700-H, ADVANCED PRACTICE SERVICES
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-7320
Mailing Address - Fax:909-558-7873
Practice Address - Street 1:700 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-1003
Practice Address - Country:US
Practice Address - Phone:909-382-3535
Practice Address - Fax:909-383-3830
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2016-01-08
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Provider Licenses
StateLicense IDTaxonomies
CA19063363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics