Provider Demographics
NPI:1659350445
Name:OPENE, LORELEI MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:MARIE
Last Name:OPENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LORELEI
Other - Middle Name:MARIE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1671
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:27871 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6404
Practice Address - Country:US
Practice Address - Phone:949-364-5090
Practice Address - Fax:949-364-5427
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP55361Medicare UPIN
CAAY823Medicare PIN
CAAY823ZMedicare PIN