Provider Demographics
NPI:1346060860
Name:MARK C. O'BRIEN, D.O., INC.
Entity type:Organization
Organization Name:MARK C. O'BRIEN, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CONWAY
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-889-1763
Mailing Address - Street 1:6786 VERMARINE CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-1705
Mailing Address - Country:US
Mailing Address - Phone:760-889-1763
Mailing Address - Fax:
Practice Address - Street 1:161 THUNDER DR STE 210
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6052
Practice Address - Country:US
Practice Address - Phone:760-889-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty