MEDICARE: PATRICIA 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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	251075	NY
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A83264	CA

General Provider Information

NPI Number	:	1700098282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA PARK

Provider Business Mailing Address
First Line	:	28078 BAXTER RD STE 530
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-1405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40663 MURRIETA HOT SPRINGS RD
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-9022
Country	:	US
Telephone Number	:	951-200-6791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/16/2022

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Directions to “ PATRICIA PARK ” Practice Location

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