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General NPI Number Information
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NPI Number | 1255490157
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Entity Type | Organization
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Legal Business Name | MARY POONEN, M.D., INC.
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 16052 BEACH BLVD SUITE 214
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3801
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Country | US
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Telephone | 714-544-9466
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Fax | 714-849-5482
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Provider Business Mailing Address
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Address Line | 36 LAURELWOOD
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City | IRVINE
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State | CA
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Zip | 92620-1299
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Country | US
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Telephone | 714-544-9466
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Fax | 714-849-5482
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Authorized Official
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Title or Position | OWNER
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Name | MARY POONEN
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Credential | M.D.
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Telephone | 714-544-9466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC33147
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CO41790
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License Number State | CA
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