Provider Demographics
NPI:1972360568
Name:OCONNOR, PAVLO
Entity Type:Individual
Prefix:
First Name:PAVLO
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3987 HEPBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2734
Mailing Address - Country:US
Mailing Address - Phone:917-710-2668
Mailing Address - Fax:
Practice Address - Street 1:27201 TOURNEY RD STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1854
Practice Address - Country:US
Practice Address - Phone:917-710-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist