Provider Demographics
NPI:1962735548
Name:PATIN-ALLRED, MARY DENISE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DENISE
Last Name:PATIN-ALLRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26051 BLASCOS
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5819
Mailing Address - Country:US
Mailing Address - Phone:949-461-1552
Mailing Address - Fax:949-582-2463
Practice Address - Street 1:707 BROADWAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5391
Practice Address - Country:US
Practice Address - Phone:858-410-1067
Practice Address - Fax:619-533-6007
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health