Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 01067582A | IN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 01067582A | IN |
NPI | 1245382852 |
---|---|
Provider Name | Fabian Jorge Arnaldo |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200969320 | (05) | IN |