Provider Demographics
NPI:1154500700
Name:ARBOLADA MEDICAL GROUP
Entity Type:Organization
Organization Name:ARBOLADA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN FNP
Authorized Official - Phone:805-646-0151
Mailing Address - Street 1:1320 MARICOPA HWY STE E
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3154
Mailing Address - Country:US
Mailing Address - Phone:805-646-0151
Mailing Address - Fax:805-646-0594
Practice Address - Street 1:1320 MARICOPA HWY STE E
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3154
Practice Address - Country:US
Practice Address - Phone:805-646-0151
Practice Address - Fax:805-646-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB334482261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11861Medicare PIN