Healthcare Provider Details

I. General information

NPI: 1649141920
Provider Name (Legal Business Name): BRIAN PAUL O'NEAL CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 W SOUTHERN AVE STE 7
MESA AZ
85210-4972
US

IV. Provider business mailing address

7127 E JACOB AVE
MESA AZ
85209-4027
US

V. Phone/Fax

Practice location:
  • Phone: 480-461-1940
  • Fax: 480-461-3855
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED2705
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPED2705
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPED2705
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: