Provider Demographics
NPI:1053406025
Name:OFFENHEISER, MARY ANN (CNS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:OFFENHEISER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 ENTORNO ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1374
Mailing Address - Country:US
Mailing Address - Phone:949-374-9245
Mailing Address - Fax:949-751-2432
Practice Address - Street 1:30240 RANCHO VIEJO RD STE C1
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1515
Practice Address - Country:US
Practice Address - Phone:949-374-9245
Practice Address - Fax:949-751-2432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA2458364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP48742Medicare UPIN
CAEK736AMedicare UPIN