Individual
JOE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15447 W SAND ST, VICTORVILLE, CA 92392-2904
(760) 843-9679
(760) 245-3618
Mailing address
15447 W SAND ST, VICTORVILLE, CA 92392-2904
(760) 843-9679
(760) 245-3618
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
A86588
CA
208VP0000X
Pain Medicine Physician
A86588
CA
208VP0014X
Interventional Pain Medicine Physician
A86588
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A865880
—
CA
Enumeration date
07/06/2006
Last updated
03/07/2023
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