MEDICARE: MR. ANTONIO LORENZO ARBOLEDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	A46476	CA

General Provider Information

NPI Number	:	1639141740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTONIO LORENZO ARBOLEDA M.D.

Provider Business Mailing Address
First Line	:	5325 LA CANADA BLVD
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-1724
Country	:	US
Telephone Number	:	818-790-2358
Fax Number	:	818-790-7048

Provider Business Practice Location Address
First Line	:	2211 W MAGNOLIA BLVD
Second Line	:	SUITE 210
City	:	BURBANK
State	:	CA
Zip	:	91506-1753
Country	:	US
Telephone Number	:	818-391-2400
Fax Number	:	818-391-2409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	01/13/2012

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