Provider Demographics
NPI:1720118961
Name:O'CONNOR, GABRIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31852 COAST HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6764
Mailing Address - Country:US
Mailing Address - Phone:949-499-5338
Mailing Address - Fax:949-499-7959
Practice Address - Street 1:31852 COAST HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6764
Practice Address - Country:US
Practice Address - Phone:949-499-5338
Practice Address - Fax:949-499-7959
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49115207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01222Medicare UPIN
CAA49115Medicare PIN