Provider Demographics
NPI:1376057802
Name:SUNBRIDGE PSYCH
Entity Type:Organization
Organization Name:SUNBRIDGE PSYCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCH CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OFFENHEISER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS BC
Authorized Official - Phone:949-374-9245
Mailing Address - Street 1:6 ENTORNO ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1374
Mailing Address - Country:US
Mailing Address - Phone:949-374-9245
Mailing Address - Fax:949-751-2432
Practice Address - Street 1:30240 RANCHO VIEJO RD STE C1
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1515
Practice Address - Country:US
Practice Address - Phone:949-374-9245
Practice Address - Fax:949-751-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2458364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty