Individual
LISA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 BON AIR RD STE 101, LARKSPUR, CA 94939-1134
(415) 924-2515
Mailing address
5 BON AIR RD STE 101, LARKSPUR, CA 94939-1134
(415) 924-2515
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
57.027085
OH
208C00000X
Colon & Rectal Surgery Physician
Primary
A168789
CA
Other
Enumeration date
04/01/2015
Last updated
12/03/2021
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