Healthcare Provider Details

I. General information

NPI: 1811264906
Provider Name (Legal Business Name): DAVID O'BRIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 RIVER RD
SALINAS CA
93908-9601
US

IV. Provider business mailing address

124 RIVER RD
SALINAS CA
93908-9601
US

V. Phone/Fax

Practice location:
  • Phone: 831-455-9965
  • Fax: 831-455-4777
Mailing address:
  • Phone: 831-455-9965
  • Fax: 831-455-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: