Healthcare Provider Details

I. General information

NPI: 1881038370
Provider Name (Legal Business Name): PARK PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 S DURANGO DR B107/220
LAS VEGAS NV
89113-3653
US

IV. Provider business mailing address

7345 S DURANGO DR B107/220
LAS VEGAS NV
89113-3653
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-0674
  • Fax: 702-566-4575
Mailing address:
  • Phone: 702-685-0674
  • Fax: 702-566-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO1568
License Number StateNV

VIII. Authorized Official

Name: DR. DANIEL PARK
Title or Position: OWNER
Credential: DO
Phone: 702-685-0674