Provider Demographics
NPI:1780720623
Name:ORMISTON, MARI (MD)
Entity type:Individual
Prefix:DR
First Name:MARI
Middle Name:
Last Name:ORMISTON
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 1:250 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1342
Mailing Address - Country:US
Mailing Address - Phone:650-329-9380
Mailing Address - Fax:650-329-9380
Practice Address - Street 1:250 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1342
Practice Address - Country:US
Practice Address - Phone:650-329-9380
Practice Address - Fax:650-329-9380
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA724262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA471158OtherVALUE OPTIONS PROVIDER