Provider Demographics
NPI:1225294754
Name:ARBUTHNOT, MISHAEL YVONNE (NP)
Entity Type:Individual
Prefix:
First Name:MISHAEL
Middle Name:YVONNE
Last Name:ARBUTHNOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:951-571-8518
Mailing Address - Fax:877-778-9427
Practice Address - Street 1:24853 ALESSANDRO BLVD
Practice Address - Street 2:#4
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-6102
Practice Address - Country:US
Practice Address - Phone:951-571-8518
Practice Address - Fax:877-778-9427
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18272363LF0000X
CANP18272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEFF: 7/21/14-RIVERSIMedicaid
CAEFF: 7/8/14 RIVERSIDMedicaid
CAP01376894OtherRR MEDICARE
CAEFF: 7/8/14 - M. V.Medicaid
CAEFF: 7/21/14-RIVERSIMedicaid
CAEFF: 7/8/14 RIVERSIDMedicaid
CACA129194Medicare PIN
CABJ119YMedicare UPIN