Healthcare Provider Details

I. General information

NPI: 1982746749
Provider Name (Legal Business Name): ALFREDO BIMBELA PHD, FNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 210
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1500 PALMA DR FL 2
VENTURA CA
93003-6451
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-7457
  • Fax:
Mailing address:
  • Phone: 805-284-1783
  • Fax: 888-958-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15951
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15951
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19802
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number606401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: