Dr Keith Park, is a
Psychologist based in Calimesa, California. Dr Keith Park is licensed to practice in California (license number PSY 18884) and his current practice location is
908 Park Ave, Calimesa, California. He can be reached at his office (for appointments etc.) via phone at
(909) 518-3886.
NPI number for Dr Keith Park is 1710101092 and his current mailing address is Po Box 1526, Yucaipa, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1710101092.
Healthcare Provider's Profile
| Full Name | Dr Keith Park |
|---|
| Gender | Male |
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| Speciality | Psychologist |
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| Location | 908 Park Ave, Calimesa, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1710101092
- Provider Enumeration Date: 04/11/2007
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Dr Keith Park such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1710101092 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | 0085201 (New Mexico) | Primary |
| 103T00000X | Psychologist | PSY 18884 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Keith Park is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Keith Park,
Po Box 1526,
Yucaipa, CA 92399-1435
Ph: (909) 518-3886 | Dr Keith Park,
908 Park Ave,
Calimesa, CA 92320-1148
Ph: (909) 518-3886 |
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