Provider Demographics
NPI:1023009586
Name:OFFENBERGER, TERENCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:R
Last Name:OFFENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2501 PULLMAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5511
Mailing Address - Country:US
Mailing Address - Phone:949-437-9063
Mailing Address - Fax:949-437-9069
Practice Address - Street 1:15 MAREBLU
Practice Address - Street 2:STE. 100
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3015
Practice Address - Country:US
Practice Address - Phone:949-448-0656
Practice Address - Fax:949-425-2465
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA64290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A642900Medicaid
CA00A642900Medicaid
CAWA64290CMedicare ID - Type Unspecified