Basic Information
| Provider Information | |||||||||
| NPI: | 1083720718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | KATHARINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28780 SINGLE OAK DR | ||||||||
| Address2: | STE 160 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925905528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516764193 | ||||||||
| FaxNumber: | 9517197469 | ||||||||
| Practice Location | |||||||||
| Address1: | 30420 HAUN RD | ||||||||
| Address2: | |||||||||
| City: | MENIFEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925846810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516764193 | ||||||||
| FaxNumber: | 9517191469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 04/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K6898 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A7203 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 044569403 | 05 | TX | MEDICAID | 044569404 | 05 | TX | MEDICAID | 044569401 | 05 | TX | MEDICAID |