Healthcare Provider Details

I. General information

NPI: 1700515731
Provider Name (Legal Business Name): OC FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY STE 130
ALISO VIEJO CA
92656-5330
US

IV. Provider business mailing address

5 JOURNEY STE 130
ALISO VIEJO CA
92656-5330
US

V. Phone/Fax

Practice location:
  • Phone: 949-235-6142
  • Fax:
Mailing address:
  • Phone: 949-235-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON MICHELE O'CONNOR
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 949-235-6142