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General NPI Number Information
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NPI Number | 1346879848
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Entity Type | Organization
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Legal Business Name | PINE PARK HEALTH, INC
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1901 4TH ST STE 201
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City | BERKELEY
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State | CA
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Zip | 94710-1986
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Country | US
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Telephone | 510-929-1400
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Fax | 510-929-1414
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Provider Business Mailing Address
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Address Line | PO BOX 511250
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City | LOS ANGELES
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State | CA
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Zip | 90051-7805
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Country | US
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Telephone | 510-929-1400
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Fax | 510-929-1414
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | STEPHANIE VANZEE
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Credential |
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Telephone | 469-401-8820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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