Provider Demographics
NPI:1720022619
Name:KLEINER, MICHELLE R (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:R
Last Name:KLEINER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:BLENSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN NP
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:277 RANCHEROS DR
Practice Address - Street 2:STE 301
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2976
Practice Address - Country:US
Practice Address - Phone:760-471-4073
Practice Address - Fax:619-528-4625
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10741363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP10741AMedicare PIN
S98738Medicare UPIN
CAW416Medicare PIN