Active NPI
Kelly Anne Arciniega, NP
- Pediatric Nurse Practitioner
- San Bernardino, CA
National Provider Identifier
1285907469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 19063
- Practice address
- 700 E Gilbert St
San Bernardino, CA 92415-1003 - Phone
- (909) 382-3535
- Fax
- (909) 383-3830
- NPI assigned
- Feb 17, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 19063 | CA | Primary |
Addresses
Primary practice location
700 E Gilbert St
San Bernardino, CA 92415-1003
Mailing address
11234 Anderson St
Llumc Room 6700-H, Advanced Practice Services
Loma Linda, CA 92354-2804
Phone (909) 558-7320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19063 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452211200000",
"number": "1285907469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11234 ANDERSON ST",
"address_2": "LLUMC ROOM 6700-H, ADVANCED PRACTICE SERVICES",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542804",
"telephone_number": "909-558-7320",
"fax_number": "909-558-7873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 E GILBERT ST",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924151003",
"telephone_number": "909-382-3535",
"fax_number": "909-383-3830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARCINIEGA",
"first_name": "KELLY",
"middle_name": "ANNE",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-17",
"last_updated": "2016-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "19063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.