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General NPI Number Information
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NPI Number | 1174216295
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Entity Type | Individual
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Provider Name | RUSSELL O'BRIEN FNP
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Gender | Male
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 191 S BUENA VISTA ST STE 375
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City | BURBANK
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State | CA
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Zip | 91505-4558
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Country | US
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Telephone | 818-729-0014
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Fax |
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Provider Business Mailing Address
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Address Line | 14209 RIVERSIDE DR APT 202
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2351
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Country | US
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Telephone | 916-825-1001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F11220453
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95022534
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License Number State | CA
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