Provider Demographics
NPI:1346756178
Name:ALFREDO BIMBELA
Entity Type:Organization
Organization Name:ALFREDO BIMBELA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BIMBELA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FNP, PHMHNP
Authorized Official - Phone:805-284-1783
Mailing Address - Street 1:1500 PALMA DR FL 2
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6451
Mailing Address - Country:US
Mailing Address - Phone:805-284-1783
Mailing Address - Fax:888-958-5269
Practice Address - Street 1:3585 MAPLE ST STE 233
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9148
Practice Address - Country:US
Practice Address - Phone:805-284-1783
Practice Address - Fax:888-958-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15951363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty