Healthcare Provider Details

I. General information

NPI: 1669376554
Provider Name (Legal Business Name): JOHN EDWARD OBRIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9136 SPRING LN
LA MESA CA
91941-6729
US

IV. Provider business mailing address

9136 SPRING LN
LA MESA CA
91941-6729
US

V. Phone/Fax

Practice location:
  • Phone: 619-402-2649
  • Fax:
Mailing address:
  • Phone: 619-402-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: