Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A94437 | CA |
Y | 207VE0102X | Reproductive Endocrinologist | A94437 | CA |
NPI | 1093722290 |
---|---|
Provider Name | Dr. Alice S Park |
First Address | La Jolla, CA 92037-1300 |
Second Address | La Jolla, CA 92037-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 01/12/2021 |