Basic Information
Provider Information | |||||||||
NPI: | 1528406329 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LARA JEANINE ARNDAL, M.D. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | OWENS VALLEY WOMEN'S HEALTH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 21530 | ||||||||
Address2: |   | ||||||||
City: | CARSON CITY | ||||||||
State: | NV | ||||||||
PostalCode: | 897211530 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7758842455 | ||||||||
FaxNumber: | 7758840345 | ||||||||
Practice Location | |||||||||
Address1: | 153 PIONEER LN | ||||||||
Address2: | SUITE C | ||||||||
City: | BISHOP | ||||||||
State: | CA | ||||||||
PostalCode: | 935142517 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7608732602 | ||||||||
FaxNumber: | 7608732750 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2013 | ||||||||
LastUpdateDate: | 08/14/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ARNDAL | ||||||||
AuthorizedOfficialFirstName: | LARA | ||||||||
AuthorizedOfficialMiddleName: | JEANINE | ||||||||
AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
AuthorizedOfficialTelephone: | 7608732602 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.