Individual
ANNIE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
11175 CAMPUS STREET, CSP 11015, LOMA LINDA, CA 92354
(909) 558-4910
Mailing address
11175 CAMPUS STREET, CSP 11015, LOMA LINDA, CA 92354
(909) 558-4910
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A144866
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/28/2015
Last updated
09/29/2023
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