Healthcare Provider Details

I. General information

NPI: 1639703358
Provider Name (Legal Business Name): PARK ANESTHESIA A NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 FLORENCE AVE
DOWNEY CA
90240-4014
US

IV. Provider business mailing address

2942 SIERRA CREST WAY
HACIENDA HEIGHTS CA
91745-6546
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-9351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW PARK
Title or Position: CRNA
Credential:
Phone: 323-842-6191