Healthcare Provider Details

I. General information

NPI: 1043377245
Provider Name (Legal Business Name): MICHAEL J. O'LEARY, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 CAMINO DEL RIO N STE 101
SAN DIEGO CA
92108-1716
US

IV. Provider business mailing address

3590 CAMINO DEL RIO NORTE, STE 101
SAN DIEGO CA
92108-1707
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-4903
  • Fax:
Mailing address:
  • Phone: 619-742-6587
  • Fax: 619-367-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberG56751
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL J. O'LEARY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-742-6587