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General NPI Number Information
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NPI Number | 1669208815
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Entity Type | Individual
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Provider Name | ASHLEY PARK
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 445 S FIGUEROA ST OFC 3103
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City | LOS ANGELES
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State | CA
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Zip | 90071-1602
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Country | US
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Telephone | 415-449-2813
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Fax |
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Provider Business Mailing Address
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Address Line | 26149 PARK AVE UNIT 22
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City | LOMA LINDA
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State | CA
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Zip | 92354-6128
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 140510
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License Number State | CA
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