Healthcare Provider Details

I. General information

NPI: 1538004577
Provider Name (Legal Business Name): CONNOLLY, POULIN, & TRESSAN, A MEDICAL CORPORATIOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E KATELLA AVE STE G
ORANGE CA
92867-4857
US

IV. Provider business mailing address

438 E KATELLA AVE STE G
ORANGE CA
92867-4857
US

V. Phone/Fax

Practice location:
  • Phone: 714-583-6173
  • Fax: 714-610-9373
Mailing address:
  • Phone: 714-583-6173
  • Fax: 714-610-9373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANNON CONNOLLY
Title or Position: CEO
Credential: MD
Phone: 714-583-6173