Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT 14184 | CA |
NPI | 1093192585 |
---|---|
Provider Name | Natalie Park |
First Address | San Jose, CA 95129-4934 |
Second Address | San Jose, CA 95129-4934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 04/05/2015 |