Provider Demographics
NPI:1043934532
Name:HUIZAR ARELLANO, ENEDINA
Entity type:Individual
Prefix:
First Name:ENEDINA
Middle Name:
Last Name:HUIZAR ARELLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18375 MINDANAO ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-2653
Mailing Address - Country:US
Mailing Address - Phone:909-745-6330
Mailing Address - Fax:
Practice Address - Street 1:18375 MINDANAO ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-2653
Practice Address - Country:US
Practice Address - Phone:909-745-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)