Individual
SHANE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1551 E TANGERINE RD, ORO VALLEY, AZ 85755-6213
(520) 901-3500
Mailing address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(213) 700-0178
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
233774
AZ
367500000X
Certified Registered Nurse Anesthetist
95000619
CA
Other
Enumeration date
10/31/2016
Last updated
04/28/2025
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