Healthcare Provider Details

I. General information

NPI: 1609396514
Provider Name (Legal Business Name): COURTNEY ANN O'BRIEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 1ST ST STE 380
SIMI VALLEY CA
93065-1551
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90095-5631
US

V. Phone/Fax

Practice location:
  • Phone: 805-583-7640
  • Fax: 805-583-7641
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A18469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: