MEDICARE: CONNOR PAKIN

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
1	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1386403566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR PAKIN

Provider Business Mailing Address
First Line	:	333 E BROADWAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5088
Country	:	US
Telephone Number	:	323-534-2206
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E BROADWAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5088
Country	:	US
Telephone Number	:	323-534-2206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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Directions to “ CONNOR PAKIN ” Practice Location

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