Healthcare Provider Details

I. General information

NPI: 1124512116
Provider Name (Legal Business Name): DOROTHY LAUREN OCONNOR MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N HOBART BLVD
LOS ANGELES CA
90027-1615
US

IV. Provider business mailing address

1911 N HOBART BLVD
LOS ANGELES CA
90027-1615
US

V. Phone/Fax

Practice location:
  • Phone: 323-806-6420
  • Fax:
Mailing address:
  • Phone: 323-806-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number964533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: