Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane S O'Brien, DEEPSEADIVINGIDC

Individual provider Military Health Care Provider · NPI 1790248375

Shane S O'Brien, DEEPSEADIVINGIDC is a Military Health Care Provider in Imperial Beach, California. Practices as a sole proprietor. Registered with an NPI since 2019.

In the registry since
2019

Practice location Address checks out

842 Georgia St
Imperial Beach, CA 91932-2343
Phone: (619) 869-1952
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Military Health Care Provider (primary) Taxonomy 171000000X

Record details

NPI number1790248375
Entity typeIndividual (Type 1)
GenderMale
Credentials DEEPSEADIVINGIDC
Sole proprietorYes
NPI enumeratedApril 10, 2019
Last updated in NPPESApril 10, 2019

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