Healthcare Provider Details

I. General information

NPI: 1558517284
Provider Name (Legal Business Name): BETHANY MARIE STELNICKI O'CONNOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 DOVER DR STE 120
NEWPORT BEACH CA
92663-6941
US

IV. Provider business mailing address

881 DOVER DR STE 120
NEWPORT BEACH CA
92663-6941
US

V. Phone/Fax

Practice location:
  • Phone: 949-381-1169
  • Fax: 949-520-6662
Mailing address:
  • Phone: 949-381-1169
  • Fax: 949-520-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA117317
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA117317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: