Individual
SHANE S O'BRIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DEEP SEA DIVING IDC
Contact information
Practice address
842 GEORGIA ST, IMPERIAL BEACH, CA 91932-2343
(619) 869-1952
Mailing address
842 GEORGIA ST, IMPERIAL BEACH, CA 91932-2343
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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