Provider Demographics
NPI:1083720718
Name:O'BRIEN, KATHARINE M (DO)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28780 SINGLE OAK DR
Mailing Address - Street 2:STE 160
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5528
Mailing Address - Country:US
Mailing Address - Phone:951-676-4193
Mailing Address - Fax:951-719-7469
Practice Address - Street 1:30420 HAUN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6810
Practice Address - Country:US
Practice Address - Phone:951-676-4193
Practice Address - Fax:951-719-1469
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6898207Q00000X
CA20A7203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044569403Medicaid
TX044569404Medicaid
TX044569401Medicaid
TXTBX100098Medicare PIN
TX080151820Medicare PIN
TX8600J2Medicare PIN
TX81724KMedicare PIN