Provider Demographics
NPI:1578015608
Name:O'BRIEN, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:ISLETON
Mailing Address - State:CA
Mailing Address - Zip Code:95641-0232
Mailing Address - Country:US
Mailing Address - Phone:916-919-6712
Mailing Address - Fax:
Practice Address - Street 1:327 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1738
Practice Address - Country:US
Practice Address - Phone:707-374-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist