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General NPI Number Information
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NPI Number | 1134770811
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Entity Type | Individual
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Provider Name | MR. RYAN MICHAEL OCONNELL
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Gender | Male
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1401 W 1ST ST
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City | SANTA ANA
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State | CA
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Zip | 92703-3757
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Country | US
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Telephone | 714-542-9700
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Fax | 714-542-9708
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Provider Business Mailing Address
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Address Line | 610 LAGUNA RD
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City | FULLERTON
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State | CA
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Zip | 92835-2434
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Country | US
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Telephone | 858-291-2503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA58938
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License Number State | CA
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