Healthcare Provider Details

I. General information

NPI: 1114400959
Provider Name (Legal Business Name): PAUL O'BRIEN DI FLAURO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIRMOUNT AVE STE 412
PASADENA CA
91105-3154
US

IV. Provider business mailing address

800 FAIRMOUNT AVE STE 412
PASADENA CA
91105-3154
US

V. Phone/Fax

Practice location:
  • Phone: 626-898-9797
  • Fax: 626-737-2685
Mailing address:
  • Phone: 626-898-9797
  • Fax: 626-737-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number808423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: