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Organization
PINE PARK HEALTH, INC
Active
Organization
PINE PARK HEALTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARIEL CABLE (CREDENTIALING MANAGER)
(480) 475-6531
Entity
Organization
Contact information
Practice address
1901 4TH ST STE 201, BERKELEY, CA 94710-1986
(510) 929-1400
(510) 929-1414
Mailing address
PO BOX 511250, LOS ANGELES, CA 90051-7805
(510) 929-1400
(510) 929-1414
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
04/06/2020
Last updated
09/02/2026
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