Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 94022490 | CA |
Y | 103T00000X | Psychologist | 94022490 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 94022490 | CA |
NPI | 1578116455 |
---|---|
Provider Name | Ronald V Park II |
First Address | Santa Barbara, CA 93111-2400 |
Second Address | Santa Barbara, CA 93111-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2019 |
Last Update Date | 19/07/2019 |