Provider Demographics
NPI:1003302605
Name:VERHINES, JEREMY R (NP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:VERHINES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32565 GOLDEN LANTERN ST # B479
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3261
Mailing Address - Country:US
Mailing Address - Phone:949-750-7082
Mailing Address - Fax:252-250-2029
Practice Address - Street 1:31877 DEL OBISPO ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3228
Practice Address - Country:US
Practice Address - Phone:949-503-1766
Practice Address - Fax:252-250-2029
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009393363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003302605OtherNPI