Organization
DIANE PARK MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE PARK MD (OWNER)
(480) 204-2477
Entity
Organization
Contact information
Practice address
1845 S DOBSON RD, SUITE 109, MESA, AZ 85202-5661
(480) 204-2477
Mailing address
1845 S DOBSON RD, SUITE 109, MESA, AZ 85202-5661
(480) 204-2477
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
32107
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609946672
INDIVIDUAL NPI NUMBER
AZ
Enumeration date
11/15/2012
Last updated
11/15/2012
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