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SHANE S O'BRIEN DEEP SEA DIVING IDC
NPI 1790248375
Military Health Care Provider in Imperial Beach, CA

Active since April 10, 2019
842 GEORGIA ST, IMPERIAL BEACH, CA 91932(619) 869-1952 Get Directions Write a Review

NPPES record last updated: April 10, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shane S O'brien Deep Sea Diving Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE S O'BRIEN DEEP SEA DIVING IDC (NPI 1790248375) is an individual military health care provider provider in Imperial Beach, California and active in the NPI registry since April 2019.

NPPES Registry Identity

NPI1790248375
Entity TypeIndividualMale
Primary Taxonomy171000000X
Provider Legal NameSHANE S O'BRIENCredential: DEEP SEA DIVING IDC
Location Address842 GEORGIA STImperial Beach, CA 91932-2343
Mailing Address842 Georgia StImperial Beach, CA 91932-2343
Phone(619) 869-1952
Sole ProprietorYes
Enumeration DateApril 10, 2019
✔ NPI 1790248375 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care ProviderOther Service Providers
Taxonomy Code171000000X
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
842 GEORGIA ST, Imperial Beach, CA 91932
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane O'brien's NPI number?

The NPI number for Shane O'brien is 1790248375. It was assigned to this individual provider in the NPPES registry on April 10, 2019.

Where is Shane O'brien located?

Shane O'brien practices at 842 Georgia St, Imperial Beach, CA 91932. The listed phone number is (619) 869-1952.

What is Shane O'brien's specialty?

The primary specialty registered for this NPI is Military Health Care Provider with taxonomy code 171000000X.

When was this NPI record last updated?

The NPPES record for Shane O'brien was last updated on April 10, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.