Healthcare Provider Details

I. General information

NPI: 1417986613
Provider Name (Legal Business Name): MICHAEL JOSEPH O'LEARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 12/18/2015
Certification Date:
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 N STE 101
SAN DIEGO CA
92108-1716
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-4903
  • Fax: 619-229-4947
Mailing address:
  • Phone: 619-229-4903
  • Fax: 619-229-4947

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:
Title or Position:
Credential:
Phone: