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NPI Code Detail

MEDICARE: ANGELA PARK

MEDICARE: ANGELA PARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist159514CA

General Provider Information

NPI Number : 1104447341
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA PARK
Provider Business Mailing Address
First Line : 324 S DIAMOND BAR BLVD # 1001
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-1607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 324 S DIAMOND BAR BLVD # 1001
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-1607
Country : US
Telephone Number : 626-424-3667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2020
Last Update Date : 12/13/2025

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Directions to “ ANGELA PARK ” Practice Location

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