Organization
ELVIN PARK, NP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELVIN PARK NP (CEO)
(805) 701-1437
Entity
Organization
Contact information
Practice address
1534 N MOORPARK RD # 327, THOUSAND OAKS, CA 91360-5129
(805) 701-1437
Mailing address
1534 N MOORPARK RD # 327, THOUSAND OAKS, CA 91360-5129
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11908
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WNP11908B
PTAN
—
Enumeration date
03/20/2008
Last updated
04/24/2009
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