Healthcare Provider Details

I. General information

NPI: 1427620459
Provider Name (Legal Business Name): MERCY PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/15/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 250
FOOTHILL RANCH CA
92610-2854
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR STE 250
FOOTHILL RANCH CA
92610-2854
US

V. Phone/Fax

Practice location:
  • Phone: 213-800-3692
  • Fax:
Mailing address:
  • Phone: 213-800-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: