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General NPI Number Information
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NPI Number | 1154500700
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Entity Type | Organization
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Legal Business Name | ARBOLADA MEDICAL GROUP
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 1320 MARICOPA HWY STE E
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City | OJAI
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State | CA
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Zip | 93023-3154
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Country | US
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Telephone | 805-646-0151
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Fax | 805-646-0594
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Provider Business Mailing Address
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Address Line | 1320 MARICOPA HWY STE E
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City | OJAI
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State | CA
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Zip | 93023-3154
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Country | US
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Telephone | 805-646-0151
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Fax | 805-646-0594
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MARY EVAN
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Credential | RN FNP
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Telephone | 805-646-0151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | B334482
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License Number State | CA
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