Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A137068 | CA |
N | 207T00000X | Neurosurgeon | 125059436 | IL |
NPI | 1093001737 |
---|---|
Provider Name | Anne Elizabeth Park |
First Address | San Diego, CA 92120-2507 |
Second Address | San Diego, CA 92120-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 15/12/2021 |