| Mary Poonen, M.d., Inc. | |
|
16052 Beach Blvd Suite 214 Huntington Beach CA 92647-3801 | |
| (714) 544-9466 | |
| (714) 849-5482 |
| Full Name | Mary Poonen, M.d., Inc. |
|---|---|
| Speciality | Counselor |
| Location | 16052 Beach Blvd, Huntington Beach, California |
| Authorized Official Name and Position | Mary Poonen (OWNER) |
| Authorized Official Contact | 7145449466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Poonen, M.d., Inc. 36 Laurelwood Irvine CA 92620-1299 Ph: (714) 544-9466 | Mary Poonen, M.d., Inc. 16052 Beach Blvd Suite 214 Huntington Beach CA 92647-3801 Ph: (714) 544-9466 |
| NPI Number | 1255490157 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 07/07/2009 |
| Medicare PECOS PAC ID | 1658425087 |
|---|---|
| Medicare Enrollment ID | O20090819000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255490157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MFC33147 (California) | Secondary |
| 101YP2500X | Counselor - Professional | CO41790 (California) | Primary |
| Provider Name | Mary Poonen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780675256 PECOS PAC ID: 4183778525 Enrollment ID: I20090819000298 |
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