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General NPI Number Information
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NPI Number | 1700312295
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Entity Type | Individual
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Provider Name | IAN O'BRIEN AGNP-BC
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Gender | Male
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 5757 PLAZA DR
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City | CYPRESS
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State | CA
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Zip | 90630-5000
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Country | US
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Telephone | 407-335-8226
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Fax |
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Provider Business Mailing Address
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Address Line | 12026 HOFFMAN ST UNIT 101
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City | STUDIO CITY
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State | CA
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Zip | 91604-4726
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Country | US
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Telephone | 321-223-8361
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11002144
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License Number State | FL
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