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General NPI Number Information
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NPI Number | 1487188744
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Entity Type | Individual
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Provider Name | TYRONE PARKS
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Gender | Male
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 525 N PARKER ST
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City | ORANGE
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State | CA
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Zip | 92868-1323
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Country | US
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Telephone | 562-316-5397
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Fax |
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Provider Business Mailing Address
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Address Line | 223 E MOUNTAIN VIEW ST
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City | LONG BEACH
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State | CA
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Zip | 90805-6439
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Country | US
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Telephone | 562-316-4397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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