Healthcare Provider Details

I. General information

NPI: 1427204494
Provider Name (Legal Business Name): EUNICE PARK ROBERTSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EUNICE Y PARK

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2000
  • Fax:
Mailing address:
  • Phone: 650-742-2000
  • Fax: 877-738-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125054114
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036129750
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA123137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: