Provider Demographics
NPI:1659365591
Name:ARLENE J. EISENBERG
Entity type:Organization
Organization Name:ARLENE J. EISENBERG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-640-9744
Mailing Address - Street 1:1074 S LA LUNA AVE
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3516
Mailing Address - Country:US
Mailing Address - Phone:805-640-9744
Mailing Address - Fax:805-640-9757
Practice Address - Street 1:1074 S LA LUNA AVE
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3516
Practice Address - Country:US
Practice Address - Phone:805-640-9744
Practice Address - Fax:805-640-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40809207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G408090Medicaid
CAE25154Medicare UPIN
CA00G408090Medicaid