MEDICARE: CHRISTY PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95036963	CA

General Provider Information

NPI Number	:	1023673803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY PARK

Provider Business Mailing Address
First Line	:	2952 VIEJO RIDGE NORTH DR
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92679-1647
Country	:	US
Telephone Number	:	714-788-9790
Fax Number	:

Provider Business Practice Location Address
First Line	:	2952 VIEJO RIDGE NORTH DR
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92679-1647
Country	:	US
Telephone Number	:	714-788-9790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	11/26/2025

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Directions to “ CHRISTY PARK ” Practice Location

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