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General NPI Number Information
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NPI Number | 1700098282
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Entity Type | Individual
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Provider Name | PATRICIA PARK
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 40663 MURRIETA HOT SPRINGS RD
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City | MURRIETA
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State | CA
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Zip | 92562-9022
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Country | US
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Telephone | 951-200-6791
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Fax |
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Provider Business Mailing Address
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Address Line | 28078 BAXTER RD STE 530
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City | MURRIETA
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State | CA
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Zip | 92563-1405
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 251075
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A83264
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License Number State | CA
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