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General NPI Number Information
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NPI Number | 1306558507
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Entity Type | Organization
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Legal Business Name | B OCONNOR MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 881 DOVER DR STE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-6941
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Country | US
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Telephone | 949-381-1169
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Fax | 949-520-6662
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Provider Business Mailing Address
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Address Line | 881 DOVER DR STE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-6941
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Country | US
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Telephone | 949-381-1169
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Fax | 949-520-6662
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETHANY MARIE STELNICKI O'CONNOR
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Credential | MD
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Telephone | 949-381-1169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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