Healthcare Provider Details

I. General information

NPI: 1578116455
Provider Name (Legal Business Name): RONALD V PARK II MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 S PATTERSON AVE STE 120
SANTA BARBARA CA
93111-2400
US

IV. Provider business mailing address

334 S PATTERSON AVE STE 120
SANTA BARBARA CA
93111-2400
US

V. Phone/Fax

Practice location:
  • Phone: 805-689-3174
  • Fax:
Mailing address:
  • Phone: 805-689-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number94022490
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94022490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: