Provider Demographics
NPI:1609317767
Name:O'CONNOR, ROD S (CPO)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:S
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1287 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1603
Mailing Address - Country:US
Mailing Address - Phone:714-635-2650
Mailing Address - Fax:714-635-0223
Practice Address - Street 1:1287 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1603
Practice Address - Country:US
Practice Address - Phone:714-635-2650
Practice Address - Fax:714-635-0223
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist