Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0216X | Pediatric Rheumatologist | 38583 | TN |
Y | 2080P0216X | Pediatric Rheumatologist | C52377 | CA |
NPI | 1861458002 |
---|---|
Provider Name | Dr. Edsel Arce-Hernandez |
First Address | Madera, CA 93638-8761 |
Second Address | Madera, CA 93638-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H27153 | (02) |