Provider Demographics
NPI:1053357137
Name:OBRIEN, CHARLES B (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21391 PINETREE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7558
Mailing Address - Country:US
Mailing Address - Phone:714-335-9024
Mailing Address - Fax:
Practice Address - Street 1:21391 PINETREE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7558
Practice Address - Country:US
Practice Address - Phone:714-335-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79283207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A792830Medicaid
CA00A792830Medicaid
H96683Medicare UPIN