Park, Larry A
Park, Larry A is an individual health care provider with primary practice located at 7000 Boulder Ave , Highland CA 92346-3348. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Park, Larry A can be contacted via phone (909) 862-1191.Contact Information
Primary practice address
7000 Boulder Ave
Highland CA 92346-3348
Phone: (909) 862-1191
Fax: (909) 796-4158
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | G30292 | California |
Profile Details
| NPI number | 1275572984 |
|---|---|
| LBN Legal business name | Park, Larry A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275572984 | NPPES |
| California | MEDICAID | 00G302920 |
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