Provider Demographics
NPI:1780851808
Name:O'REILLY, MARYELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYELLEN
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYELLEN
Other - Middle Name:
Other - Last Name:DEBONIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:60 DISCOVERY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3105
Mailing Address - Country:US
Mailing Address - Phone:949-586-9904
Mailing Address - Fax:949-586-7816
Practice Address - Street 1:60 DISCOVERY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3105
Practice Address - Country:US
Practice Address - Phone:949-586-9904
Practice Address - Fax:949-586-7816
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63194208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice