Healthcare Provider Details

I. General information

NPI: 1679463186
Provider Name (Legal Business Name): BRIAN O'DONNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E RIVER PARK PL W
FRESNO CA
93720-1551
US

IV. Provider business mailing address

5633 MONALEE AVE
SACRAMENTO CA
95819-2423
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-4950
  • Fax:
Mailing address:
  • Phone: 916-698-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: