Healthcare Provider Details

I. General information

NPI: 1700054467
Provider Name (Legal Business Name): PATRICK LAWRENCE O'REILLY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY.
NAPA CA
94558-6293
US

IV. Provider business mailing address

2100 NAPA VALLEJO HWY.
NAPA CA
94558-6293
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-5000
  • Fax: 707-253-5513
Mailing address:
  • Phone: 707-253-5000
  • Fax: 707-253-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number18019
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number18019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: