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Shane S O'brien, DEEPSEADIVINGIDC
Military Health Care Provider in Imperial Beach, California
NPI 1790248375

Shane S O'brien is a Military Health Care Provider based in Imperial Beach, CA. Shane S O'brien practices in Imperial Beach, CA and has the professional credentials of DEEPSEADIVINGIDC. The NPI Number for Shane S O'brien is 1790248375 and holds a License No. (California).

The current practice location address for Shane S O'brien is 842 Georgia St, Imperial Beach, CA and can be reached out via phone at 619-869-1952.

Location: 842 Georgia St, Imperial Beach, CA, 91932-2343
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790248375
Provider Name
Shane S O'brien
Credential
DEEPSEADIVINGIDC
Provider Entity Type
Individual
Gender
Male
Address
842 Georgia St, Imperial Beach, CA, 91932-2343
Phone Number
619-869-1952
Fax Number
Provider Enumeration Date
04/10/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
842 Georgia St
City
Imperial Beach
State
California
Zip
91932-2343
Phone Number
619-869-1952
Fax Number
person
Provider Business Mailing Address Details
Address
842 Georgia St
City
Imperial Beach
State
California
Zip
91932-2343
Phone Number
619-869-1952
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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