Healthcare Provider Details

I. General information

NPI: 1598879793
Provider Name (Legal Business Name): JEANNINE A. O'BRIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE SUITE 235
CARMICHAEL CA
95608-0302
US

IV. Provider business mailing address

2001 RATTLESNAKE RD SUITE 235
NEWCASTLE CA
95658-9722
US

V. Phone/Fax

Practice location:
  • Phone: 916-200-0087
  • Fax:
Mailing address:
  • Phone: 916-663-2100
  • Fax: 916-663-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA14186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: