Healthcare Provider Details

I. General information

NPI: 1407192057
Provider Name (Legal Business Name): BRANDON J O'BRIEN R.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 E DENISE AVE
ORANGE CA
92867-1816
US

IV. Provider business mailing address

2614 E DENISE AVE
ORANGE CA
92867-1816
US

V. Phone/Fax

Practice location:
  • Phone: 714-264-4685
  • Fax:
Mailing address:
  • Phone: 714-264-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2357
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: