Provider Demographics
NPI:1871619189
Name:ANNEKE ARELLANO MD, LLC
Entity type:Organization
Organization Name:ANNEKE ARELLANO MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-949-9333
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0040
Mailing Address - Country:US
Mailing Address - Phone:480-949-9333
Mailing Address - Fax:480-949-9334
Practice Address - Street 1:3301 N MILLER RD
Practice Address - Street 2:138
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6431
Practice Address - Country:US
Practice Address - Phone:480-949-9333
Practice Address - Fax:480-949-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0777070OtherBCBS OF AZ
AZH62147Medicare UPIN
AZ104546Medicare PIN