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General NPI Number Information
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NPI Number | 1265183628
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Entity Type | Organization
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Legal Business Name | MINDFUL SPECIALTY ASSOCIATES
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 24040 CAMINO DEL AVION STE E196
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City | DANA POINT
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State | CA
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Zip | 92629-4005
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Country | US
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Telephone | 714-617-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 24040 CAMINO DEL AVION STE E196
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City | DANA POINT
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State | CA
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Zip | 92629-4005
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Country | US
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Telephone | 714-617-0001
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ROBERT HEINEMEIER
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Credential |
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Telephone | 714-617-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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