Healthcare Provider Details

I. General information

NPI: 1023512431
Provider Name (Legal Business Name): DANIEL O'BRIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DEEP VALLEY DR STE 100
ROLLING HILLS ESTATES CA
90274-7606
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-3953
  • Fax: 310-303-7903
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA165839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: