Healthcare Provider Details

I. General information

NPI: 1053406025
Provider Name (Legal Business Name): MARY ANN OFFENHEISER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30240 RANCHO VIEJO RD STE C1
SAN JUAN CAPISTRANO CA
92675-1515
US

IV. Provider business mailing address

6 ENTORNO ST
RANCHO MISSION VIEJO CA
92694-1374
US

V. Phone/Fax

Practice location:
  • Phone: 949-374-9245
  • Fax: 949-751-2432
Mailing address:
  • Phone: 949-374-9245
  • Fax: 949-751-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number2458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: