Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | A24057 | CA |
NPI | 1073684007 |
---|---|
Provider Name | Theodore X. O'connell |
First Address | Los Angeles, CA 90027-6021 |
Second Address | Los Angeles, CA 90027-6021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 23/09/2008 |