Healthcare Provider Details

I. General information

NPI: 1336077874
Provider Name (Legal Business Name): SEAN AUGUSTINE ODWYER CA PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12599 ALCOSTA BLVD
SAN RAMON CA
94583-9027
US

IV. Provider business mailing address

9630 BRINDLE CT
ELK GROVE CA
95757-8371
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-6634
  • Fax:
Mailing address:
  • Phone: 916-799-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP19167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: