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General NPI Number Information
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NPI Number | 1063332534
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Entity Type | Organization
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Legal Business Name | RICHARD PARK, MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 10515 BALBOA BLVD STE 325
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6364
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Country | US
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Telephone | 805-368-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 10515 BALBOA BLVD STE 325
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6364
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Country | US
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Telephone | 805-368-1293
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHELSEA EMBER
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Credential |
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Telephone | 615-522-4079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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