Healthcare Provider Details

I. General information

NPI: 1538563010
Provider Name (Legal Business Name): MICHAEL OBRIEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6382 HORSESHOE BAR RD
LOOMIS CA
95650-9706
US

IV. Provider business mailing address

6382 HORSESHOE BAR RD
LOOMIS CA
95650-9706
US

V. Phone/Fax

Practice location:
  • Phone: 916-607-9868
  • Fax:
Mailing address:
  • Phone: 916-607-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number494829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: