Active NPI
Dominick Charles Aretino, OTR
- Occupational Therapy Assistant
- Gallup, NM
National Provider Identifier
1396713699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 831
- Practice address
- 516 Nizhoni Blvd
Gallup, NM 87301-5748 - Phone
- (505) 722-1000
- Fax
- (505) 722-1226
- NPI assigned
- Mar 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 831 | NM | Primary |
Addresses
Primary practice location
516 Nizhoni Blvd
Gallup, NM 87301-5748
Mailing address
PO Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000R8788 | Medicaid | NM | |
| 553629 | Medicaid | AZ |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 831 | NM | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1396713699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1337",
"city": "GALLUP",
"state": "NM",
"postal_code": "873051337",
"telephone_number": "505-722-1000",
"fax_number": "505-722-1226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 NIZHONI BLVD",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015748",
"telephone_number": "505-722-1000",
"fax_number": "505-722-1226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARETINO",
"first_name": "DOMINICK",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NM",
"license": "831",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000R8788",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "553629",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.