Basic Information
| Provider Information | |||||||||
| NPI: | 1801088042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANN R. CONNOR, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800817 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913800817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612950859 | ||||||||
| FaxNumber: | 6612950862 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 E CESAR CHAVEZ AVENUE | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232761860 | ||||||||
| FaxNumber: | 3232767424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | CONNOR | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3232761860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | G67226 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 00G672260 | 05 | CA | MEDICAID |