Healthcare Provider Details

I. General information

NPI: 1568541951
Provider Name (Legal Business Name): JAMES C O'CONNELL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 37TH AVE
SAN MATEO CA
94403-4324
US

IV. Provider business mailing address

90 BAYVIEW ST
SAN FRANCISCO CA
94124-2339
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2958
  • Fax:
Mailing address:
  • Phone: 415-637-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 27503
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95020240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: