Basic Information
| Provider Information | |||||||||
| NPI: | 1730302134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENOS | ||||||||
| FirstName: | MURIEL | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | RNC.,PHY.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 REDBUD | ||||||||
| Address2: | |||||||||
| City: | RANCHO SANTA MARGARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926881116 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 W 5TH ST STE 212 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148342125 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 380278 | CA | X | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 103TB0200X | PSY20957 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No ID Information.