Healthcare Provider Details

I. General information

NPI: 1376171330
Provider Name (Legal Business Name): CONNOR FARRELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17762 BEACH BLVD STE 100
HUNTINGTON BEACH CA
92647-6860
US

IV. Provider business mailing address

17762 BEACH BLVD STE 100
HUNTINGTON BEACH CA
92647-6860
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-0080
  • Fax: 714-848-0080
Mailing address:
  • Phone: 714-848-0080
  • Fax: 714-848-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A21362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: