Basic Information
| Provider Information | |||||||||
| NPI: | 1225294754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARBUTHNOT | ||||||||
| FirstName: | MISHAEL | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 OCEANGATE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908024317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515718518 | ||||||||
| FaxNumber: | 8777789427 | ||||||||
| Practice Location | |||||||||
| Address1: | 24853 ALESSANDRO BLVD | ||||||||
| Address2: | #4 | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925536102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515718518 | ||||||||
| FaxNumber: | 8777789427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 18272 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | NP18272 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | EFF: 7/21/14-RIVERSI | 05 | CA | MEDICAID | EFF: 7/8/14 RIVERSID | 05 | CA | MEDICAID | P01376894 | 01 | CA | RR MEDICARE | OTHER | EFF: 7/8/14 - M. V. | 05 | CA | MEDICAID |