Provider Demographics
NPI:1497744247
Name:O'BRIEN, MARK C (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:O'BRIEN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 THUNDER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6052
Mailing Address - Country:US
Mailing Address - Phone:760-216-6500
Mailing Address - Fax:760-295-4753
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:760-216-6500
Practice Address - Fax:760-295-4753
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20A6017LMedicare ID - Type Unspecified
C84521Medicare UPIN