Provider Demographics
NPI:1306199831
Name:O'CONNOR HOSPITAL
Entity Type:Organization
Organization Name:O'CONNOR HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-947-2515
Mailing Address - Street 1:PO BOX 742797
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2797
Mailing Address - Country:US
Mailing Address - Phone:408-947-2500
Mailing Address - Fax:
Practice Address - Street 1:2105 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1425
Practice Address - Country:US
Practice Address - Phone:408-947-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:O'CONNOR HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-22
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0063391291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC00153HMedicaid
CAHSP40153HMedicaid
CACGP032465Medicaid
CAZZZR00153HMedicaid
CAHSC00153HMedicaid
CA050153Medicare PIN