Organization
PAUSE2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NITA ARROYO USERO OTRL (OWNER)
(910) 392-8021
Entity
Organization
Contact information
Practice address
1705 FORDHAM RD, WILMINGTON, NC 28403-7111
(910) 392-8021
(910) 338-0034
Mailing address
1410 MARBLEHEAD CT, WILMINGTON, NC 28412-2086
(910) 392-8021
(910) 338-0034
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0962
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0162L
BCBSNC
NC
05
—
7210493
—
NC
05
—
7384584
—
NC
Enumeration date
06/06/2007
Last updated
08/04/2008
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