# ELVIN PARK, NP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699946434
- **Authorized official:** MR. ELVIN PARK NP (CEO)
- **Authorized official phone:** (805) 701-1437

## Contact information

- **Practice address:** 1534 N MOORPARK RD \# 327, THOUSAND OAKS, CA 91360-5129
- **Practice address phone:** (805) 701-1437
- **Mailing address:** 1534 N MOORPARK RD \# 327, THOUSAND OAKS, CA 91360-5129

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 11908 | CA | Yes |

## Other

- **Enumeration date:** 03/20/2008
- **Last updated:** 04/24/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | WNP11908B | PTAN | — |