Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E5802 | CA |
N | 222Z00000X | Podiatrist | E5802 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E5802 | CA |
N | 2081S0010X | Sports Medicine | E5802 | CA |
N | 213ES0000X | Sports Medicine | E5802 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E5802 | CA |
NPI | 1356901078 |
---|---|
Provider Name | Dr. Laura-Ashley Oconnell |
First Address | Upland, CA 91786-3854 |
Second Address | Upland, CA 91786-3854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 14/02/2022 |