Provider Demographics
NPI:1588121826
Name:ARAIZA CHAVEZ, MANUEL ARNOLDO
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ARNOLDO
Last Name:ARAIZA CHAVEZ
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 1:1011 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3410
Mailing Address - Country:US
Mailing Address - Phone:760-550-2446
Mailing Address - Fax:
Practice Address - Street 1:1011 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-3410
Practice Address - Country:US
Practice Address - Phone:760-550-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8CTW539344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi