Provider Demographics
NPI:1043030067
Name:ANDALON, ARIELE ANUVA (PA-C)
Entity type:Individual
Prefix:
First Name:ARIELE
Middle Name:ANUVA
Last Name:ANDALON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BRUSH OAK CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5992
Mailing Address - Country:US
Mailing Address - Phone:805-559-1599
Mailing Address - Fax:
Practice Address - Street 1:1700 N ROSE AVE STE 320
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7648
Practice Address - Country:US
Practice Address - Phone:805-485-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64936363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant