Provider Demographics
NPI:1760437230
Name:HAAS, MAUREEN E (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:HAAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 TEJAS PL
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6440
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-269-1500
Practice Address - Fax:805-269-1585
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71031FMedicaid
CAPPG: M 2791OtherHEALTH NET
CAHAP7131FOtherFAMILY PLANNING
CAW1508CMedicare PIN
CA551983Medicare Oscar/Certification
CAW1508Medicare PIN
CAFHC71031FMedicaid
CACO230YMedicare PIN
CAPPG: M 2791OtherHEALTH NET
CAHAP7131FOtherFAMILY PLANNING
CACO230ZMedicare PIN
CAW1508AMedicare PIN