Healthcare Provider Details

I. General information

NPI: 1861503187
Provider Name (Legal Business Name): PATRICK JOSEPH O'CONNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W VALLEY BLVD
TEHACHAPI CA
93561-2119
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-2530
  • Fax: 661-822-2536
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG72720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: