Provider Demographics
NPI:1639141740
Name:ARBOLEDA, ANTONIO LORENZO (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:LORENZO
Last Name:ARBOLEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 LA CANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1724
Mailing Address - Country:US
Mailing Address - Phone:818-790-2358
Mailing Address - Fax:818-790-7048
Practice Address - Street 1:2211 W MAGNOLIA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1753
Practice Address - Country:US
Practice Address - Phone:818-391-2400
Practice Address - Fax:818-391-2409
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46476171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA754513Medicare PIN
CA00A464760Medicare UPIN