Provider Demographics
NPI:1619702016
Name:VAN AMBURG, ARDEN L
Entity type:Individual
Prefix:
First Name:ARDEN
Middle Name:L
Last Name:VAN AMBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19847 SELENE CT
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4301
Mailing Address - Country:US
Mailing Address - Phone:818-288-5970
Mailing Address - Fax:
Practice Address - Street 1:3491 CAHUENGA BLVD W UNIT A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1338
Practice Address - Country:US
Practice Address - Phone:818-431-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-305255174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty