Provider Demographics
NPI:1720282403
Name:ARIAS, JOSE LEONEL
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LEONEL
Last Name:ARIAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 FREEDOM BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2752
Mailing Address - Country:US
Mailing Address - Phone:831-763-8211
Mailing Address - Fax:
Practice Address - Street 1:12 W BEACH ST STE 219
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4504
Practice Address - Country:US
Practice Address - Phone:831-763-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA7114461OtherDL