Healthcare Provider Details

I. General information

NPI: 1972985083
Provider Name (Legal Business Name): O'CONNOR HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OCONNOR DR SUITE 200
SAN JOSE CA
95128-1633
US

IV. Provider business mailing address

455 OCONNOR DR SUITE 200
SAN JOSE CA
95128-1633
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-7676
  • Fax:
Mailing address:
  • Phone: 408-283-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JENA EIDSCHUN
Title or Position: MANAGER, FAMILY MEDICINE RESIDENCY
Credential: B.S., M.A.
Phone: 408-283-7676