Organization
JAMES PARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES PARK (BUSINESS MANAGER)
(505) 514-2900
Entity
Organization
Contact information
Practice address
6501 EAGLE ROCK AVE NE, SUITE A6, ALBUQUERQUE, NM 87113-2478
(505) 514-2900
Mailing address
6501 EAGLE ROCK AVE NE, SUITE A6, ALBUQUERQUE, NM 87113-2478
(505) 514-2900
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
866RX1
NM
225100000X
Physical Therapist
Primary
2074
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45139024
—
NM
01
—
7645703
AETNA
—
Enumeration date
10/08/2012
Last updated
10/08/2012
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