SHANE S O'BRIEN DEEP SEA DIVING IDC NPI 1790248375

NPI Information

Shane S O'brien, DEEP SEA DIVING IDC is a military health care provider in Imperial Beach, CA. The provider is active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. Shane S O'brien, DEEP SEA DIVING IDC NPI is 1790248375. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

842 GEORGIA ST
IMPERIAL BEACH, CA
ZIP 91932-343
Phone: (619) 869-1952

The enumeration date for this NPI number is 4/10/2019 and was last updated on 4/10/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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