Provider Demographics
NPI:1174999866
Name:ARELLANO, MARIANA
Entity type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:
Last Name: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 1:3412 LIVERNOIS AVE.
Mailing Address - Street 2:APT2
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210
Mailing Address - Country:US
Mailing Address - Phone:313-520-5284
Mailing Address - Fax:
Practice Address - Street 1:3412 LIVERNOIS AVE.
Practice Address - Street 2:APT2
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2945
Practice Address - Country:US
Practice Address - Phone:313-520-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA645585009270247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI247200000Other247200000