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NPI Code Detail

MEDICARE: JOHN D OCONNELL CDAC

MEDICARE: JOHN D OCONNELL CDAC
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
1170300000XGenetic Counselor (M.S.)CA
2170300000XGenetic Counselor (M.S.)
3101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1770622961
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN D OCONNELL CDAC
Provider Business Mailing Address
First Line : 5870 ARLINGTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92504-2037
Country : US
Telephone Number : 951-683-6596
Fax Number :
Provider Business Practice Location Address
First Line : 5870 ARLINGTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92504-2037
Country : US
Telephone Number : 951-683-6596
Fax Number : 951-683-4239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 12/09/2022

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Directions to “ JOHN D OCONNELL CDAC” Practice Location

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