| Diane Park Md Llc | |
|
1845 S Dobson Rd Suite 109 Mesa AZ 85202-5661 | |
| (480) 204-2477 | |
| Not Available |
| Full Name | Diane Park Md Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1845 S Dobson Rd, Mesa, Arizona |
| Authorized Official Name and Position | Diane Park (OWNER) |
| Authorized Official Contact | 4802042477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diane Park Md Llc 1845 S Dobson Rd Suite 109 Mesa AZ 85202-5661 Ph: (480) 204-2477 | Diane Park Md Llc 1845 S Dobson Rd Suite 109 Mesa AZ 85202-5661 Ph: (480) 204-2477 |
| NPI Number | 1972847903 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 11/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972847903 | NPI | - | NPPES |
| 1609946672 | Other | AZ | INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 32107 (Arizona) | Primary |
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