| Walter R Obrien Md Inc A Medical Corporation | |
|
11710 Wilshire Blvd Los Angeles CA 90025-1503 | |
| (310) 477-7276 | |
| (310) 477-5148 |
| Full Name | Walter R Obrien Md Inc A Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 11710 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Walter Ray O'brien (OWNER) |
| Authorized Official Contact | 3104777276 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Walter R Obrien Md Inc A Medical Corporation 11710 Wilshire Blvd Los Angeles CA 90025-1503 Ph: (310) 477-7276 | Walter R Obrien Md Inc A Medical Corporation 11710 Wilshire Blvd Los Angeles CA 90025-1503 Ph: (310) 477-7276 |
| NPI Number | 1851623029 |
|---|---|
| Provider Enumeration Date | 02/12/2010 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 7113042508 |
|---|---|
| Medicare Enrollment ID | O20101005000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851623029 | NPI | - | NPPES |
| 00G631931 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | G63193 (California) | Primary |
| Provider Name | Walter R O'brien |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1346290814 PECOS PAC ID: 0648312629 Enrollment ID: I20100129000105 |
| Provider Name | Dominic P Toscano |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801210042 PECOS PAC ID: 8224250634 Enrollment ID: I20141119000007 |
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