Individual
AUDREY O'NEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1340 N ACACIA AVE, FULLERTON, CA 92831-1202
(714) 879-6302
Mailing address
1340 N ACACIA AVE, FULLERTON, CA 92831-1202
(714) 879-6302
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000007224
BOARD OF CERTIFICATION
—
Enumeration date
05/18/2016
Last updated
05/18/2016
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