Provider Demographics
NPI:1235703273
Name:OBRIEN, KAITLYN OLGUITA CONSTANCE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:OLGUITA CONSTANCE
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KADE
Other - Middle Name:
Other - Last Name:OBRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3530
Practice Address - Country:US
Practice Address - Phone:831-458-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant