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NPI Code Detail

MEDICARE: DR. PERLA M PARK M.D

MEDICARE: DR. PERLA M PARK M.D
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
1207V00000XObstetrics & Gynecology PhysicianA48406CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518973122
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PERLA M PARK M.D
Provider Business Mailing Address
First Line : 2050 S BLOSSER RD
Second Line :
City : SANTA MARIA
State : CA
Zip : 93458-7310
Country : US
Telephone Number : 805-361-8028
Fax Number : 805-361-8097
Provider Business Practice Location Address
First Line : 2801 SANTA MARIA WAY
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-2118
Country : US
Telephone Number : 805-938-9200
Fax Number : 805-938-9207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 06/15/2015

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Directions to “ DR. PERLA M PARK M.D” Practice Location

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