Provider Demographics
NPI:1306051008
Name:ANABO, ARVIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:ARVIN
Middle Name:
Last Name:ANABO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ARVIN
Other - Middle Name:
Other - Last Name:ANABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10399 LEMON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3771
Mailing Address - Country:US
Mailing Address - Phone:909-373-0216
Mailing Address - Fax:909-373-1902
Practice Address - Street 1:10399 LEMON AVE STE 101
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3771
Practice Address - Country:US
Practice Address - Phone:909-373-0216
Practice Address - Fax:909-373-1902
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16689363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16689OtherSTATE LICENSE