Healthcare Provider Details

I. General information

NPI: 1962333054
Provider Name (Legal Business Name): KATRINA GILLARD O'CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14626 GUNDRY AVE
PARAMOUNT CA
90723-3235
US

IV. Provider business mailing address

15110 CALIFORNIA AVE
PARAMOUNT CA
90723-4378
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-8040
  • Fax:
Mailing address:
  • Phone: 650-678-5999
  • Fax: 562-602-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: