Healthcare Provider Details

I. General information

NPI: 1316440753
Provider Name (Legal Business Name): CHASTITY LYNN O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 ALHAMBRA AVE
SANTA MARIA CA
93458-8337
US

IV. Provider business mailing address

1836 ALHAMBRA AVE
SANTA MARIA CA
93458-8337
US

V. Phone/Fax

Practice location:
  • Phone: 805-554-1801
  • Fax:
Mailing address:
  • Phone: 805-554-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT34279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: