Individual
KELLY PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-4000
Mailing address
15808 PARRY PEAK DR, FONTANA, CA 92336-4642
(909) 910-1989
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E5531
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
E5531
CA
213ES0131X
Foot Surgery Podiatrist
E5531
CA
Other
Enumeration date
07/08/2016
Last updated
06/05/2024
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