Individual
KEITH PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22570 FIRENZE ST, CARSON, CA 90745-3635
(310) 351-0942
Mailing address
22570 FIRENZE ST, CARSON, CA 90745-3635
(310) 351-0942
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
347C00000X
Private Vehicle
—
—
347E00000X
Transportation Broker
—
—
Other
Enumeration date
01/08/2024
Last updated
01/08/2024
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