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General NPI Number Information
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NPI Number | 1790738698
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Entity Type | Individual
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Provider Name | SARA E.Q. PARK MD
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4000 N CENTRAL AVE COMPREHENSIVE MEDICAL & DENTAL, AZDCS, SITECODE C041-22
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City | PHOENIX
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State | AZ
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Zip | 85012-1959
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Country | US
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Telephone | 602-771-3638
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Fax | 602-351-8529
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Provider Business Mailing Address
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Address Line | PO BOX 29202 COMPREHENSIVE MEDICAL & DENTAL, AZDCS, SITECODE C041-22
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City | PHOENIX
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State | AZ
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Zip | 85038-9202
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Country | US
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Telephone | 602-771-3638
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Fax | 602-351-8529
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 23844
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License Number State | AZ
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