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General NPI Number Information
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NPI Number | 1538004577
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Entity Type | Organization
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Legal Business Name | CONNOLLY, POULIN, & TRESSAN, A MEDICAL CORPORATIOM
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 438 E KATELLA AVE STE G
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City | ORANGE
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State | CA
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Zip | 92867-4857
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Country | US
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Telephone | 714-583-6173
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Fax | 714-610-9373
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Provider Business Mailing Address
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Address Line | 438 E KATELLA AVE STE G
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City | ORANGE
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State | CA
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Zip | 92867-4857
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Country | US
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Telephone | 714-583-6173
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Fax | 714-610-9373
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Authorized Official
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Title or Position | CEO
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Name | DR. SHANNON CONNOLLY
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Credential | MD
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Telephone | 714-583-6173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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