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NPI Code Detail

MEDICARE: ALDA M O'CONNOR FNP

MEDICARE: ALDA M O'CONNOR FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0024167708VA
2363LF0000XFamily Nurse Practitioner828844CA

General Provider Information

NPI Number : 1265603294
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALDA M O'CONNOR FNP
Provider Business Mailing Address
First Line : 116 LION CIR
Second Line :
City : CHULA VISTA
State : CA
Zip : 91910-3164
Country : US
Telephone Number : 985-707-5984
Fax Number :
Provider Business Practice Location Address
First Line : 1241 E DYER RD STE 145
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-5694
Country : US
Telephone Number : 985-707-5984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2008
Last Update Date : 03/25/2013

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