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General NPI Number Information
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NPI Number | 1376057802
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Entity Type | Organization
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Legal Business Name | SUNBRIDGE PSYCH
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 30240 RANCHO VIEJO RD STE C1
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1515
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Country | US
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Telephone | 949-374-9245
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Fax | 949-751-2432
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Provider Business Mailing Address
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Address Line | 6 ENTORNO ST
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City | RANCHO MISSION VIEJO
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State | CA
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Zip | 92694-1374
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Country | US
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Telephone | 949-374-9245
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Fax | 949-751-2432
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Authorized Official
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Title or Position | PSYCH CLINICAL NURSE SPECIALIST
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Name | MS. MARY ANN OFFENHEISER
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Credential | PMHCNS BC
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Telephone | 949-374-9245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 2458
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License Number State | CA
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